Primarily, CISCL is being used by psychiatric units -- about 60 of them, both large and small, at hospitals and clinics in the U.S., Spain, Portugal, Brazil, Mexico and Taiwan (languages are easily flipped in the CISCL interface). But the Strains have plans to broaden Micro-Cares' audience to include other disciplines, which would entail modifying the datasets. Jay Strain says he's currently working on systems designed for surgery, internal medicine, geriatrics and pediatrics. At Slone-Kettering in New York, a pediatric oncology unit is currently experimenting with CISCL.
Profit doesn't appear to be the object: often, the Strains will give the software away. At other times, they'll arrange funding from outside sources to help pay for the cost of equipment and setting the system up. Eli Lilly, for instance, funds the program's use at a hospital in Portugal.
There has been some resistance to its implementation, however. At Memorial Hospital in New York, the psych unit discontinued its use of Micro-Cares because of a mandate from on high to use only the hospital's legacy computer systems for storing records. And at a hospital in Australia, use of Micro-Cares has also been discontinued, after the head of psychiatry, a CISCL supporter, retired. "You have to have someone in there who's interested in monitoring data, seeing its quality, and working with it," James Strain says, explaining the situation in Australia. "But his successor wasn't interested in doing all that work."
Perhaps because of this resistance, the Strains are working hard to market another piece of the Micro-Cares line, called MedTrack, which is almost the inverse of CISCL. Instead of tracking patients, it gathers information on the performance and experience of medical students. The goal is to make sure that students receive adequate training. As they make their rounds, students use handheld devices to record which patients they've seen and what they've done while administering to them. The Strains' idealism shines through here as well. Jay strain says, "Did they observe, or did they perform, or did they teach a procedure as a medical student? That information has never been captured before. Did they deliver a baby or experience a drug-drug interaction? Or did they get through medical school without delivering baby, without seeing drug-drug interaction? I think there's a tremendous gap between where we could be with our teaching and where we are now."