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At 03:03 PM 3/20/97 -0500, you wrote:
>Would anyone have an article or book in mind that compares
>vertical to horizontal delivery systems? I've done a HSTAR
>search and have found 1 article (not very elaborate). This is
>for the CEO of course tomorrow MORNING!

Hi Joanne,

I don't have any citations that would authenticate the following in a
manner that would satisfy the CEO; however, as a general concept, it may be
helpful.

Many hospitals and hospital systems that went the route of acquiring
practices and other types of services along the continuum of care are now
seriously reassessing the concept, some to the point of divesting
themselves of the practices.  In short, they have realized the gross
differences in managing small businesses (such as practices) versus
managing much larger businesses (such as hospitals).  Quite a few systems
have sustained considerable losses.

Many are beginning to look at the legal strategy for integration (purchase,
acquisition, merger, etc.) as secondary to developing interoperable
information systems that unify the entire system (regardless of its
vertical versus horizontal matrix) into a coherent, seamless network of
data sources.  They are focusing their efforts on pulling data from the
various and multiple storage places in the network (individual servers) and
converting the data into useful information that is specific and germane to
the person requesting the information.

For example, based on the nature of the encounter with the patient, the PCP
might be interested in the last 4 to 5 blood pressure readings in the
course of managing hypertension, while the specialist might want to see a
trend in some endocrine studies.  The information system would reach out to
the data stored in a variety of places in the network, compile it and
present it to the provider in real time.

The prevailing thinking is that different type of data are best captured,
stored and retrieved in different operating systems.  The financial data
might best be managed in a UNIX setting while Electronic MedRecs will do
better under Windows.

Once a provider, regardless of his/her legal relationship to the system is
integrated into this network of information, the dependency relationship
that develops, simply on the basis of the quality and accessibility of the
information, establishes a significant barrier to leaving the system.  All
in all, in most cases, then, the provider can be made a "captured" part of
the health care system without significant dollars being spent on the
particular practice.

Of course, significant dollars will be spent on the development of such
information systems but that investment will eventually be amortized over
many providers and the return on that investment will likely be much higher
than that gained from acquiring practices or ancillary providers.

As a final thought, one of the greatest barriers to quality and utilization
management (inclusive of the development of pathways etc.) is the
availability of uniform and consistent data that can be presented to all
providers in the system.  Even the same data in different formats (one
software package spits it out one way, another package another way) is an
obstacle that physicians rarely overcome - it's just too much work.

Best regards,

Bill Braun

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