Assessing the introduction of enterprise-wide clinical information systems in pediatric medical center

Advances in computer technology have enabled the evolution from traditionally paper-based medical record systems that are fragmented, with associated difficulties in retrieving critical information, to highly accessible and potentially integrated electronic clinical information systems. Hospitals and clinical environments that have employed electronic information systems until recently have typically done so using department or group-specific systems (i.e., by specialty or clinical practice) offered by separate vendors that are often implemented incrementally. This approach, frequently described as best of breed, has been justified when the individual component systems are deemed the best available options for a given application, even if multiple vendor systems that do not interface are ultimately employed. More recent implementation strategies have involved deployment of single vendor, integrated systems across the entire hospital enterprise. A shift from the best of breed strategy toward the enterprise-wide single vendor application strategy has happened due to cost, medical record fragmentation, strain on the institution's technical and support infrastructure, and the emergence of vendor products designed to serve multiple application needs under a single umbrella. This article builds off our implementation experience at Children's Hospital Boston to describe considerations, including potential benefits and pitfalls, of introducing an enterprise-wide clinical information system in a tertiary care pediatric center.