Buying a Clinical Information Technology System

Buying a clinical information technology system challenges every organization’s senior management team. Unlike other administrative applications that help manage a facility, the clinical information technology system touches directly the lives of patients and the work flow of physicians, nurses, and other clinicians. Careers and entire organizations can be ruined by poor vendor choices and botched implementations (e.g., installation of the software and hardware) and deployments (e.g., introduction of applications to end users). Poorly chosen clinical information technology systems can drive physicians to competitor institutions, impact facility accreditation, and in some cases invite litigation due to unexpected morbidity or mortality.

As frightening as this task is, the best way to be successful is to be humble. Senior executives must accept the fact that full investigation of the features and functionality of clinical information technology systems before purchase is impossible. No individual or committee has the technical expertise and available time to effectively evaluate and fully review the capabilities of a comprehensive clinical information technology system. Therefore, organizations must base their decision to purchase systems on factors that function as surrogates for the usefulness and appropriateness of the systems in its institutions. These may include such items as the source of clinical content included with the system, list of organizations using the system, and perceived ease of use of the application.

Evaluate Live Systems

Although information technology vendors utilize demonstrations of their software to educate clients about their products, viewing working systems deployed in patient care areas offers the most valuable information. Unfortunately for both vendors and purchasers, the competitiveness of the healthcare information technology marketplace, couple with the complexity of these systems, encourages vendors to showcase software products during demonstrations that are either partially completed or are in beta version.

Therefore, often what is seen in these demonstrations does not accurately represent the features and functionality currently available. It is important to take vendors at their word when they declare that the demonstrated software is representative of features and functionality under development.

Focus on Deployed Working Systems Only

To increase the probability of purchasing a product that will satisfy the needs of an organization, institutions most focus on existing, working, deployed, and implemented versions of the applications being considered for purchase. The best way to evaluate current-state versions of applications is to visit current clients of each vendor and to witness the daily use of the various applications. Organizations must be patient and allocate adequate time to see the systems working under all conditions. This includes visiting multiple hospitals and various patient care areas throughout each hospital.

Forge Solid Vendor Relationships

For most organizations, it is more prudent to engage in relationships with vendors that have established working applications that can be immediately deployed and utilized. Although working, released software will have its inevitable share of problems, it is likely there will be fewer problems and solutions will be readily found.

In some cases, it may be advantageous to engage in relationships with vendors that are offering software that hast just been released or is under development. In these instances, organizations must enter the agreement recognizing the potential benefits from such arrangements but also the problems and delays in the software that may be associated with purchasing new, untested software. Organizations that do not have extensive information technology infrastructure and departments should be wary of entering into these types of arrangements.

The following sections outline a recommended process for choosing clinical information technology for an institution.

Review and Embrace Strategic Vision

The purchase of all clinical information technology tools must be driven by the clinical strategic vision of the organization. The strategic vision represents the views and aspirations of the board of directors, the medical staff, and other clinical professionals in the organization. Clearly, cost control is always a consideration, but the importance of patient safety and quality healthcare overwhelmingly drives decision making.

Broadly Explore Options

A high level of evaluation of your organization will quickly identify the potential suppliers of the application software required. In almost all cases, there will be a relatively small number of vendors who provide software that meets the needs of an organization. Identification of these vendors can be done through a request for information process ( RFI ), searching the Internet, and contacting colleagues at institutions similar to one’s own.

Understand the Vendor

As relationships with application vendors extend far beyond the implementation phase, a strong, open, and trusting relationship is necessary to be able to ensure that implemented software will deliver the expected results to an organization. Because problems will arise, a positive relationship is required to ensure that problems are resolved. A good relationship with a vendor, as exhibited by respectful an honest interactions with all representatives of the organization, unequivocally trumps perceived advantages in features and functionality that might be seen in other products.

Evaluate The Product

The best way to evaluate clinical information technology applications is to actually see them functioning in a real working environment. Unless an organization is working as a development partner with a vendor, various client organizations, comparable to the purchasing institution, should be available to be visited to observe the applications being used by clinical professionals.

Purchasing organizations must budget more than one day to visit these client organizations and see the applications being used at a variety of times during the day. Workloads vary, with morning physician rounds often presenting the greatest demands upon systems because of their high number of new patient orders and the need for patient care documentation. In addition, evening use represents a time when information technology staffing may be low or system maintenance may occur.

Organizations should request that their representatives be allowed to visit patient care areas unencumbered and be able to ask questions of the various users of the applications. The more institutions visited, the better the information that can be collected to evaluate the applications and the vendor.

Understand Pricing

Vendor pricing is greatly influenced by the level of ongoing maintenance payments, the strategic value of the organization to the vendor, and market forces. Therefore, in negotiating products with vendors, be sure to take a very broad and considered view of the products, services, and support being provided.

Cost of ownership includes not only the purchase price of the software but also the ongoing maintenance fee to the vendor and the cost of implementing, deploying, and maintaining the system during its life. Finally, the importance of the quality of the relationship with the vendor cannot be overemphasized, as it will have the greatest impact on the success of implementation and, eventually,clinician adoption.

Secure Adoption

Implementing clinical information technology without broad involvement and support by the clinical staff-requiring focus on all stakeholders, including physicians, nurses, pharmacists, and other health professionals-all but guarantees a failed and wasteful deployment. Clinical information technology systems alone do not fix clinical problems, advance safety, or reduce costs by themselves. These systems provide tools that can be used by clinicians to change how they deliver care. Only with clinician creativity, insight, and experience molding the implementation can new processes deployed with these tools deliver acceptable work flows and generate good outcomes.

If deployment is poor and disruptive, clinicians will create work-arounds to these failing system processes, a development that guarantees medical errors and unacceptable waste. By securing adoption, organizations can be assured of usable systems that are embraced by clinicians and that are able to deliver expected and much-needed clinical and financial outcomes.

Distributed Generation Technologies – Applications and Challenges

The practice of installing and operating electric generating equipment at or near the site of where the power is used is known as “distributed generation” (DG). Distributed generation provides electricity to customers on-site or supports a distribution network, connecting to the grid at distribution level voltages.

The traditional model of electricity generation in the United States, which may be referred to as “central” generation, consists of building and operating large power plants, transmitting the power over distances and then having it delivered through local utility distribution systems.

The practice of installing and operating electric generating equipment at or near the site of where the power is used is known as “distributed generation” (DG). Distributed generation provides electricity to customers on-site or supports a distribution network, connecting to the grid at distribution level voltages. DG technologies include engines, small (and micro) turbines, fuel cells, and photovoltaic systems.

Distributed generation may provide some or all of customers’ electricity needs. Customers can use DG to reduce demand charges imposed by their electric utility or to provide premium power or reduce environmental emissions. DG can also be used by electric utilities to enhance their distribution systems. Many other applications for DG solutions exist.

With existing technology, every industrial or commercial facility including factories, campuses, hospitals, hotels, department stores, malls, airports, and apartment buildings can generate enough electricity to meet its power needs under normal conditions, as well as have back-up power during a blackout.

Distributed generation systems can provide an organization with the following benefits:

* Peak Shaving;

* On-site backup poer during a voluntary interruption;

* Primary power with backup power provided by another supplier;

* Combined load heat and power for your own use;

* Load following for improved power quality or lower prices;

* To satisfy your preference for renewable energy

In conjunction with combined heat and power (CHP) applications, DG can improve overall thermal efficiency. On a stand-alone basis, DG is often used as back-up power to enhance reliability or as a means of deferring investment in transmission and distribution networks, avoiding network charges, reducing line losses, deferring construction of large generation facilities, displacing expensive grid-supplied power, providing alternative sources of supply in markets, and providing environmental benefits.

Power generation technologies have evolved significantly in the past decade, making DG much more efficient, clean, and economically viable.

Substantial efforts are being made to develop environmentally sound and cost-competitive small-scale electric generation that can be installed at or near points of use in ways that enhance the reliability of local distribution systems or avoid more expensive system additions. Examples of these distributed resources include fuel cells, efficient small gas turbines, and photovoltaic arrays.

This report on Distributed Generation Technologies takes an in-depth look at the industry and analyzes the various technologies that contribute to distributed generation in today’s age. The report focuses on these technologies through case studies, examples, and equations and formulas. The report also contains analysis of the leading countries actively promoting distributed generation.

Oliver Lawal: A UV Technology Innovator

Oliver Lawal is like many scientists and engineers in the UV technology field, with intellectual interests that span a wide range. At the University of Manchester England, where he studied electrical, mechanical and software engineering, “I couldn’t decide on one field of study,” recalled Lawal, “so I graduated with multiple degrees and an understanding of several areas.”

Since then, Lawal has lived and worked in six different countries and his expertise contributed to many important projects in UV technology applications. “My first involvement with UV was as a Project Manger in the United Kingdom. I worked on the first large-scale UV installation using variable power electronic ballasts driving low-pressure amalgam lamps,” remembered Lawal. After this, he worked on a UV installation at a nuclear power station in France. Lawal then went on to work on the largest UV wastewater project in the world (at that time) in Auckland, New Zealand.

All of these endeavors have contributed to Lawal’s outlook and vision for UV technology. In this growing field, technology is evolving quickly. Lawal refers to this growth as the water-energy-technology nexus. “We have the ability to help ensure sustainability of our most precious resources for future generations by developing better and better technical solutions to our water and energy stresses,” commented Lawal.

Oliver Lawal’s family has been involved with the energy industry for some time. His grandfathers were motor sport enthusiasts and this helped to stimulate his initial interest in technology and engineering. Yet it was Lawal’s parents’ interest in environmental issues that ultimately led him to a career in water. He recalls his father’s comments about the difference in experiencing oil or water shortages expressed this way: “If we run out of oil tomorrow, we’ll all be driving electric cars. But, if we run out of clean water tomorrow, driving will be the least of our problems.”

Lawal’s professional life is challenging and rewarding. Today, he’s a board member with International Ultraviolet Association (IUVA) and he is president of Aquionics Inc., a company with a 30-year track record in selling and maintaining UV water disinfection technology to municipal and industrial water and wastewater markets in North America. Lawal shares a birthday with Amelia Earhart, and he professes to have the same sense of adventure as her. In his leisure time, he enjoys riding motorcycles and driving racecars, activities that reinforce his passions for technology and adventure.

The UV technology industry has changed since he began his career in the late 90s and it will continue to evolve. “From the perspective of equipment design and operation there is no question that our ability to more accurately predict and control process performance has increased dramatically,” notes Lawal. New techniques such as computational fluid dynamics, microbiological assays, power control and UV-C monitoring are more refined and more commonplace now. “This has resulted in great improvements in energy consumption and a reduction in operational risk,” observes Lawal.

Lawal believes that growth and improvement in UV water disinfection technology has a direct impact on the public health, by controlling pathogens in public water and wastewater supplies. “The sheer breadth of applications seen today, targeting very specific results, is staggering,” says Lawal. “The reduction of endocrine disrupting compounds, total organic compounds, ozone, chloramine, chlorine, cryptosporidium and viruses are commonplace and the applications using them expanding,” he added. Applications that are directly impacted include: ballast water, combined sewage overflows, aquatics, hydraulic fracturing, medical devices, semi-conductors, pharmaceuticals and more.

As president of a leading provider of UV technology, Lawal maintains a focused approach with a close eye towards ethical concerns. “It is important that we do not take shortcuts for short term commercial gains,” he says. “As the sphere and influence of UV technology grows, and new technical solutions like UV-LED’s become available, we need to ensure all stakeholders: regulators, process designers and users understand the critical issues. Regulation is important – it must be robust yet enabling. Process design must be sound and ensure seamless integration with other technologies. And ultimately the technology must be executed in a manner that allows safe and reliable operation.”

There is no doubt that the cleanliness of water impacts the lives of people worldwide. By focusing his life’s work on improving the quality of public water and wastewater with UV technology, Lawal is reiterating his parents’ vision for a cleaner environment and taking the necessary actions to implement this by working towards these goals on a daily basis.