January 16, 2004

Study: exceptional information resources found at VUMC

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Dr. Clifton K. Meador serves as the executive director of the Meharry-Vanderbilt Alliance. Photo by Dana Johnson

Study: exceptional information resources found at VUMC

Vanderbilt University Medical Center rated highest in a recent comparison of the strength and functionality of clinical enterprise information technology in use at 22 U.S. medical centers. In the comparison, VUMC achieved an IT “functionality score” that was 50 percent above the group average.

At the same time, total VUMC clinical enterprise applications costs per user were near the group average.

These and other findings emerged from an assessment performed for VUMC this summer by Gartner, Inc., a leading analyst of the productivity, efficiency and quality of enterprise information technology.

“We engaged Gartner because we wanted to know how we’re doing, whether we’re spending too much, and how we can improve on our investment in information technology,” said Donna L. Forsythe, department administrator of the Informatics Center.

The Gartner assessment included two overlapping views of VUMC costs. One view looked at $17.2 million in clinical enterprise applications costs. This view included the infrastructure to support those applications. The second view looked at $22.2 million in information technology infrastructure costs. This view included infrastructure to support education and research, as well as the clinical enterprise.

Dr. Bill W. Stead, associate vice chancellor for Health Affairs and director of the Informatics Center, said, “For the people who’ve had to understand our IT strategy and decide budgets, this is the first benchmark data that examines how well the strategy is working.”

Because the role of clinical enterprise information technology at VUMC is so highly visible, people assume an inordinate amount money is being spent on it, Stead said. “That’s not the case,” he said. In addition to finding the applications portfolio to be of average cost, Gartner’s analysis found that, after accounting for variations in functionality, IT infrastructure costs at VUMC are 29 percent below average. “There are no huge undiscovered savings in the data,” Stead said.

“We have a need to help our customers understand what we’re doing and why,” he said. “In particular, we continue to need to focus on communication and tools that help people know how to get things done.” A retreat sponsored last summer by Stead and other leaders has set in motion a number of changes to help the Informatics Center improve service to teams and departments across the medical center.

The report helped to answer a range of questions that have occupied decision makers at Vanderbilt. There has been a question of whether in-house development of applications slows deployment of technology at VUMC. The finding that the VUMC applications portfolio delivers exceptionally high functionality argues against any slowed deployment, Stead and Forsythe said. Stead said a growing hunger for information technology leads to a perception among staff and faculty that it takes a long time to get new IT functions into production at VUMC.

“It’s a reaction to our success, not a result of any actual slowing,” he said. “Success increases appetite and causes unmet hunger that is fairly acute.”

The problem with purchasing applications is that customers often find the products don’t do what is needed and they end up not being used, Stead said. “What we’ve done is build systems that use techniques from this new science of biomedical informatics to link information into the user’s normal workflow.”

The result is an exceptionally strong applications portfolio at a cost that is average. “The trade-off between vendor packages and in-house developed applications appears to be benefiting the organization,” Stead said.

He said there has been some question of whether VUMC is devoting IT resources to exciting new areas such as clinical decision support at the expense of hospital and clinic operations.

To help determine whether there are information technology gaps at VUMC, Gartner’s analysis of the clinical enterprise was broken into processes of arranging care, delivering care, accounting for care, and managing health, and the applications portfolio was broken into “utility applications” such as patient registration and billing, “enhancement applications” such as the bed management system, and “transformational applications” such as WizOrder (physician order entry and clinical decision support). Functionality in all areas was above comparison group averages.

Gartner found that VUMC relies less than other clients do on software to support technical users. Infrastructure staffing costs are 9 percent above average, while infrastructure software costs are 72 percent below average. Stead and Forsythe said they’ll be looking at opportunities for using more automation to help technical staff handle tasks associated with network management and the Help Desk.

While Gartner’s consultants found exceptional breadth and depth of clinical enterprise information technology at Vanderbilt, the medical center appeared to be behind in use of IT for chronic disease management and for direct patient transactions. It turns out that these opportunities had already been addressed in the 2004 budget: the VUMC patient portal (My Vanderbilt) is growing in functionality, and the StarTracker component of the StarPanel application is becoming a powerful tool for chronic disease management.

Gartner also found high costs for IT disaster recovery at VUMC, but again the opportunity had already been sighted: taking advantage of improved technology, in fiscal years 2004-05 the Informatics Center will cut more than $800,000 from these costs, while reducing the expected system down time in a disaster from several hours to just minutes.

The report is aiding understanding among decision makers and others. “Once a year they worry about what we cost,” Stead said, “and the rest of the year they worry about how we can get more done.

“I didn’t engage Gartner as a step in an internal marketing process,” he said. “It’s part of a long search for ways to carry out the strategy more efficiently and effectively.

“The challenge in benchmarking information technology involves normalizing service levels in a way that lets you get at the cost of a particular set of functionality. There is a lot of variability in what systems do and how much infrastructure is employed, and Gartner’s is the leading model for using data from different sites to derive clear comparisons.”

For assessment of the VUMC applications portfolio the comparison group was limited to Gartner’s recently assessed health care clients — 22 in all. To assess different aspects of VUMC’s IT infrastructure, Gartner used multiple comparison groups representing a range of industries. Infrastructure includes computers and other hardware, certain software, such as operating systems and desktop applications, and staffing to train and support users and support operation of computers and systems software.

While staffing costs for in-house applications development were included in the assessment, the substantial income VUMC has earned from licensing its WizOrder application was not considered as an offset.