Work in healthcare long enough and you start see certain issues as perennial favorites. There are two factors that contribute to the “popularity” of these kinds of “favorites.” First, they are important clinically or financially, or both. Second, they include stubborn problems that are resistant to change. Ask a seasoned healthcare veteran and they can probably reel off a series of them.

If you build it, will they come? But, there was a problem. One that virtually all clinical applications face. The calculator, built as a web-based application, did not integrate with Epic, the electronic medical record (EMR) used at Cleveland Clinic. The vision of providing clinicians with a useful and important tool was stymied by the difficulty of accessing and using the calculator.

In a clinically integrated network (CIN), a group of healthcare providers come together in a purposeful and carefully orchestrated way to take economic responsibility for delivering care that is better, cheaper and provides a more satisfying experience for patients. For example, a group of orthopedic surgeons, a hospital, a rehab facility and a home health company might all join together to form a CIN that focuses on joint replacement. The insurance company would negotiate a set price for the entire episode of care and standards to ensure the quality of care is not diminished. It’s up to the CIN to figure out how best to care for the patient “on a budget” while still hitting the quality targets.

Over the last decade, U.S. health care providers made enormous investments in electronic medical records (EMRs). Given the scale of this investment and the ever-increasing pressure to do more with less, many have pursued a strategy of widely deploying a single, uniform EMR and leveraging it for as many uses as possible. It’s a logical and sound strategy as far as it goes, but it only goes so far.