Buying a Computer System for a Hospital
by
Charles Lamson
In early 1992 four hospitals in East Anglia, England, collaborated to buy a new information system from McDonnell Douglas. The group comprised Addenbrooke's in Cambridge, Norwich Acute Unit, West Suffolk and James Paget of Great Yarmouth. Their 8.3 million pound system was the largest joint proposal so far for the taxpayer-funded National Health Service (NHS) which spent approximately 250 million pounds on computer equipment that year.
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Within the NHS rising costs have become a matter of public concern and are the subject of frequent newspaper headlines and radio talk shows. Hospital managers faced stark choices with respect to IT spending: should they upgrade the mainframe or buy a kidney dialysis machine? While dialysis machines were considered to be urgent requirements, nevertheless it was recognized that computers were urgently needed to streamline hospital administration to link the increasingly broad range of hi-tech equipment.
The goal of the consortium was to create a unified system within each hospital which would hold all the patient data centrally. Traditionally, each department collected and stored its own data such as the names and addresses of the general practitioners (doctors who work in the community) of its patients. This meant that patients who needed to visit several different departments had to repeat the same information each time so that computer staff could rekey the data into a separate computer system. The new computer system would put an end to this time-wasting repetition of patient details and it would make complete patient histories available at the touch of a button throughout the hospital. However, implementing the system would be a major task, as the average medical records department holds around 3.5 billion pieces of information relating to current patients.
In the past such a major decision would not have been made at hospital level but by the local health authority. While legislation had passed decision making to the hospitals themselves. It meant that hospitals had to compete with each other for patients. Despite this, the idea of a collaborative bid was considered to be common sense. One advantage was that by pooling resources the hospitals were able to exert pressure to secure cost savings which were well in advance of anything that could have been achieved if they had acted individually. Technical expertise was also shared between the sites. This, in turn, had effects for problem solving which was shared. If one hospital encountered a difficulty with respect to system implementation everyone became involved and once it was solved everyone benefited.
Despite this there were some drawbacks. As has already been mentioned, the hospitals had to compete for patients. However, the technology itself was not thought to be an essential competitive issue. Instead competition was based on price and perceived quality of service which would flow in part from better use of the system. In any case, the hospitals had different needs: two provided general healthcare and two were specialist. Another problem was that the weakest member dictated the speed of progress. Finally, the project required a great degree of collaboration between people from different sites. Despite these drawbacks the benefits were seen to outweigh the disadvantages.
To ensure that nothing was missed out in defining the original requirements lengthy consultations were held with all categories of hospital staff, from radiographers and pathologists to administrative, catering and clinical staff. At least 150 people were involved in the discussions, so that everyone knew what was going on. A document outlining 250 individual requirements was published in August 1992. This led to thirty-nine requests for copies from computer suppliers and was followed by sixteen serious responses. Then the process of selection began. NHS procurement is governed by European Commission/World Trade Organization (EC/WTO) regulations intended to ensure fair competition. They oblige customers to debrief all would-be suppliers on the reasons why they were not selected. Although decision makers found this process to be tedious, it was a valuable exercise that forced them to examine their selection criteria. In particular, one decision maker stated that he thought that while often decisions are influenced by a mixture of subjective and objective views, people are not always honest with themselves about the subjective component. By being forced to debrief potential suppliers, decision makers had to face up to the reasons why they were making certain decisions.
To aid the selection process, the East Anglia consortium laid down specific requirements for every stage. In particular, the winning candidate would have to prove that it had the ability to pull together the existing islands of information in each hospital. For example, one supplier who offered to put together the best software on the market for each individual application was rejected while others who offered a common core took precedence, even though their separate modules might not have been quite as good.
The screening process reduced the contenders to eight. Users were then invited to test the systems. 'User feedback is essential,' said the coordinator, 'because suppliers will always try to disguise the weak points of their systems.' For example, a system might require doctors to order pathology tests individually, whereas the doctors might want tests grouped so that a request forone but automatically triggers several others. Such problems do not come to light until users are experimenting with the system.
The trials reduced the number of suppliers to four possible alternatives. Final judgement was based on technical capabilities, applications and customer support. The same two companies came out on top in all three areas. Since both suppliers could clearly meet the requirements the final decision was made on price, with adjustments to allow for the time that would need to be spent on training. Once the winner had been selected the twelve month selection process was over.
*SOURCE: FUNDAMENTALS OF MARKETING, 2007, MARILYN A. STONE AND JOHN DRESMOND, PGS. 110-111*
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