On the other side of the country, Kaiser Permanente is also implementing an outpatient clinical information system to provide caregivers access to electronic medical records with built-in lab and pharmaceutical data and inpatient information. The California organization is the nation’s largest nonprofit health plan, with 8 million members, 11,300 physicians and 80,000 PCs. It operates in 11 states and the District of Columbia and has annual revenues of $16 billion. It is investing more than $1 billion a year in IT, much of which is going to the clinical information system.

Kaiser contracted with IBM to build the system and plans to roll it out over three years, starting in Hawaii and northern California. "No one has built anything like this before in sheer scope," says Tim Sullivan, Kaiser’s senior vice president and CIO. He emphasizes that IBM and Kaiser’s IS department are working together because there is no system large enough to handle the complexity of the databases, which contain lab, pharmaceutical and inpatient information.

Although Kaiser has focused on the outpatient system, officials say the IOM report has accelerated their plans to automate the hospital order-entry inpatient side. "Our outpatient system was designed to improve our quality outcomes," says Dr. Robert Pearle, executive director and CEO of the Permanente Medical Group, a Kaiser subsidiary. "We’re constantly looking at ways to take the newest technologies and make them available across a system."

The Elusive Elixir

Doctors have been relatively slow to adopt new technologies, largely because of the complex nature of medicine and a lack of industry standards. "We’re still a very young field when it comes to information technology," says Dr. Brent James, vice president for medical research at Salt Lake City’s Intermountain Health Care, which owns LDS Hospital. "Only in the past few years have we come to a point where we could design an effective system." Computerized order-entry systems are also a large expense, coming at a time when many medical centers don’t have excess capital.

Proponents of information technology also need to prove to the medical community that computerized order entry can be more efficient. "In general, doctors have been willing to embrace all sorts of new technology, including MRIs and lasers, but they haven’t seen the value of information technology, and they’ve often been right," says Levin of Children’s. "If folks can see at the end of the day that they’ve had few interruptions-that things haven’t been slipping through the cracks-they’ll see the value of the technology."