Get with the program.

COMPUTER TECHNOLOGY HAS THE shelf life of sushi in the Sudan. While refrigerators, washer-dryers, and televisions are built to last a good ten years, desktop computers become obsolete after about three, and software is upgraded at about the same rate.

So if you're thinking about using computer technology to improve patient care, comply with goverment regulations, collect accounts receivable, or create a marketing database, or for any of the other good reasons outlined in our special technology section this month, you'd better first face the fact that it's going to require ongoing infusions of cash.

Mark Kator, president of Isabella Geriatric Center, a large skilled nursing facility in New York City, is a big believer in the importance of being generous with your IS department. "Too many administrators and board members look at information systems as a one-time investment that won't need upgrading or replacement for another decade," he says. "That strategy no longer works--you have to invest a substantial amount of money for infrastructure and upgrades."

It should come as no surprise, therefore, that the most techno-savvy providers also tend to be the best-capitalized, while smaller providers are usually left to play catchup when software comes down in price.

But even large providers are frustrated by the fact that most of the software that integrates clinical and financial data (a) was designed for acute care systems and (b) is exorbitantly priced. Some, like Isabella, are taking a best-of-breed approach, finding the best software they can for specific needs and integrating it in-house.

Others, like Princeton, New Jersey-based Presbyterian Homes and Services, are holding out for a unified package. "It comes down to support structure," explains John Meluso, director of information technology at Presbyterian. "With best of breed, you have to bring in programming staff. We're more interested in reducing our overhead."

That's why Meluso welcomes the trend of "many vendors who are buying the best of breed software and doing the integration themselves."

Whatever approach you take, it'll work better if you work closely with your vendors. "There are more patient care, quality management things we could use," says Kator. "But I don't think the industry will build it without our input, and we couldn't build it without their guidance. It has to be a partnership."

Sam Adler Senior Editor

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