University of Michigan Medical Center
Ann Arbor, Michigan
Philip J. Boyer, MD, PhD

Philip J. Boyer, MD, PhD1, Walter H. Henricks, MD1, Joan McCollum3, Roger Wilfong3, and William Bria, MD2,3
1Departments of Pathology
2Internal Medicine
3Medical Center Information Technology Division
University of Michigan Medical Center
Ann Arbor Michigan.

The computer user interface is the critical entryway to the electronic clinical medical record and databases and to online reference materials. By 1993, hardware and software components of that interface at the 950 bed University of Michigan Medical Center were badly out of date and failed to meet the needs of clinicians. For example, to evaluate laboratory and radiologic data on a single patient, separate systems needed to be accessed, necessitating a fairly complex series of maneuvers on the available terminals. In addition, on patient-care wards, there was no access to either online references like the Department of Pathology's laboratory manual or to productivity software.

In 1995, a decision was made to

update to a graphical user interface, using a self-developed system that would facilitate access to the disparate data resources of the Medical Center and upgrade and increase the availability of hardware.
The project was called Applied Clinical Informatics (ACI), and the installed software/hardware was referred to as an ACI workstation. The project was a great success, as measured by computer activity trends before and after the implementation, feedback forms (online and written), help desk inquires, feedback sessions with user groups, and direct observation during the 48 hours following the installation of clinical workstations in patient care areas. Two primary objectives were achieved:

clinicians quickly adapted to the graphical user interface, without disruption of work, and
after numerous hours of planning, incorporating detailed logistical considerations of the idiosyncrasies of each patient care area, installation of workstations was seamless, including in areas without specified "down time" like the Emergency Department.

This presentation will highlight the critical role of "clinician" input into the successful design and implementation of the ACI project. It will describe the various aspects of the ACI project, including historical perspective of the evolution of the clinical workstation, project organization, and individuals involved and constituencies represented in the management, technical, and training teams, and share "lessons learned" during the project, describing the major barriers that were overcome to succeed, and the changes in the information technology environment that resulted.

Current Affiliations: Dr. Boyer: Department of Pathology, Pennsylvania State University / M.S. Hershey Medical Center; Dr. Henricks: Division of Pathology and Laboratory Medicine, The Cleveland Clinic Foundation