Everyone acquainted with the subject knows that preventable medical errors are a major problem in health care, perhaps even the eighth leading cause of death in the United States. The ongoing challenge is how to respond to them.

Most experts agree that Clinical Information Systems (CIS) represent a core solution, providing a technological compass for guiding best-practices medical care and preventing both diagnostic and treatment errors.

But, in our opinion, Clinical Information Systems alone are not a sufficient solution. We believe hospitals today require a comprehensive, integrated organizational system, which we call a Transformation Model. Furthermore, we believe that reducing medical errors is important but not sufficient. There are other issues equally critical to the successful operation of a quality medical institution that require attention, including: eliminating waste, eliminating unnecessary variance in care delivery and eliminating delays. The Transformation Model employed by Cerner Corporation, which my Partner Rick Smith developed while leading Cerner Consulting, addresses all of these issues simultaneously and, if properly implemented, will dramatically improve the quality of healthcare delivered by our nation’s hospitals.

To envision how our model works, picture a baseball diamond. Around this diamond are five key "players," all of which are necessary for a high-performance operation. On the pitcher’s mound is the Clinical Information System itself. In the position of home plate, you’ll find Workflow Optimization. On first base is Knowledge; playing second base is Technology; and on third base is Culture. Recognizing the strengths and talents of the individual "players" – and the need for their finely synchronized coordination -- are as essential to the functioning of a best-practices medical facility as they are to the success of a world class baseball team.

A description of our five core "players" follows:

• The Clinical Information System (CIS) is the heart and soul of the operation, providing the means by which all information is captured, stored and exchanged among healthcare professionals. This includes, for example, the key medical record facts that can help prevent drug-drug interaction errors, prevent physicians from ordering the wrong dosage, or prevent nurses from administering the wrong medication. There are many systems on the market today, but none of them, in isolation, will resolve the problems in question.

• Workflow Optimization: Workflow applies to all of the activity that takes place in and around the medical process—from drug administration to surgical planning to outcomes measurement, etc. While the CIS radically changes the way all tasks are executed, workflow optimization assures elimination of waste and delays.

• Knowledge, or rather, we should say the knowledge that is embedded in the CIS. This embedded knowledge empowers "evidence-based" medicine – or best practices based upon hundreds of thousands of patient experiences. A physician can pinpoint situations that match the profile of the patient in question and determine the best treatment that will achieve the best possible outcome. Such a system augments our current standard -- "memory-based" medicine – which relies on the recall potential of the human brain to assemble the often puzzle-like pieces of medical histories, symptoms and treatment paradigms to arrive at the precise course of action. Care givers have immediate access to the best and most accurate treatment options, and patients not only receive expert care, they are also spared unnecessary expense.

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