tion they have. Externally, they want access to competitors' records to run their businesses more efficiently and improve the quality of care.
Large providers -- hospitals and health-care networks -- are replacing paper records with computerized systems to cut administrative costs. Most of them are using commercial software to do this, from integrators (e.g., HBO and Company and IDX Systems) and software developers that specialize in health care (e.g., Cerner and Meditech).
Some providers in remote locations are betting on telemedicine. They're setting up WANs that will let them consult faraway specialists. Also, insurers and HMOs ho
pe someday to be able to access patient records that predate their coverage. They can then analyze them to determine the most cost-effective treatment plans and coverage. They are already putting data-mining technology in place to analyze their own data.
However, the main action now for integrators in the health-care market is providing access to largely plain text over private links, be they intranets or Virtual Private Networks (VPNs) on the Internet, because of the privacy requirements of health-care companies.
Internet: A Fast Fix
Most large hospitals have Internet connections for research purposes, integrators say. However, few health-care companies are using the Internet or intranets to do business. Integrators expect intranet projects to increase dramatically in six months, and some are starting to line up projects in this area. The health-care industry has been slow to jump on the Internet bandwagon because of security issues.
Many integrators expect health-care c
ompanies to shy away from using the Internet to send patient information. However, they expect companies to use intranets behind firewalls to exchange encrypted data. Most firewall products come with encryption, and it's also available from third-party companies such as Viacrypt, says
Seth Nichols
, manager of the health-care market for systems integrator Charter Systems.
HBO and Company (HBOC) has several intranet pilots planned for the next few months. Some of them will let doctors search for patient information on an intranet within an enterprise.
"It will return some demographic information to identify the person with an address and phone number, and physicians will be able to look at clinical results in a grid format," says
Rusty Lewis
, HBOC's vice president of research and technology. The advantage of using a browser to access the data is that it expands the number of desktops that can access the information, because hospitals can use old systems wi
th little memory and an external modem. You can also access information remotely, saving a trip to the emergency room, from an office or a home, for example.
HBOC plans to add a Web-browser interface to its existing pharmaceutical application, which checks for conflicts between drugs and allergy reactions and manages drug orders. Again, the Web browser will let hospitals have more access points to the application, Lewis says. HBOC is using Java to allow interaction with the program, and the company also uses HTML and ActiveX in its intranet projects. For example, it is using ActiveX to give doctors read-only access to test results from different laboratories.
Cambridge Technology Partners is deploying intranets for similar reasons. The company just launched a Web-browser interface to the Disease Management System application it developed for a large hospital in PowerBuilder. Using the browser interface, physicians can look at documents such as referral letters, educational materials, and guideline
s attached to patient records, which are stored on heterogeneous systems in a variety of formats.
The Disease Management System itself -- the first electronic record system that all the departments can access -- lets the hospital change the way it treats patients, allowing a group of specialists to treat each patient as a team. The hospital has also been able to track patient treatments and outcomes to determine the best courses of treatment for a particular disease.
IDX Systems, which is one of the leading health-care integrators, recently began shipping a browser interface for its line of clinical management, billing, scheduling, and managed-care software. IDX has installed the interface, called OutReach, at four customer sites. Authorized physicians can dial into the application using any Internet connection and view certain kinds of patient information, even if they don't use IDX's software.
It will be useful when IDX's clients refer their patients to outside specialists, says Ken Kaufma
n, IDX's director of product marketing. Typically, when this happens, the specialist doesn't have the patient's chart and doesn't know what procedures the referring HMO covers. Sometimes, the referring physician will send a partial chart by courier. OutReach will give specialists instant access to financial and coverage information. A future version will provide patient-care history.
Other health-care products that make use of the Internet are starting to emerge. Charter Systems is keeping its eye on Health Vault from Healtheon (Palo Alto, CA). This electronic patient-record software is aimed at HMOs. Healtheon is also creating an application that employees can use to compare health-care packages offered by their employer. The program will be interactive, letting users enter the names of their doctors, number of dependents, and where they live to compare benefits. They can also enroll and change benefits using the application.
Electronic House Calls
Videoconferencing and multime
dia are being used to deliver specialized expertise to patients in remote areas or who are difficult to move, such as prisoners.
One of the most interesting projects in the videoconferencing area is a pilot that was put together by Charter Systems for Fletcher Allen Healthcare (Burlington, VT). The project -- Fletcher has just received funding for it and put out a Request for Proposal (RFP) -- will create a regional health network linking about 750 doctors in the area with telemedicine, e-mail, and Internet access for research.
The pilot system Charter created used PC-based teleconferencing products from V-Tel and PictureTel along with Intel's ProShare. Physicians can attach medical appliances such as a stethoscope to a Pentium PC and transmit the information. The teleconferencing system, which used two 128-Kbps ISDN lines, can also transmit x-rays, full-motion video, and ultrasound images. The video runs at 30 frames per second and has a latency of less than one-tenth of a second. Each telemedici
ne PC will cost approximately $11,000, Charter estimates. Fletcher plans to put one on every physician's desktop so they can consult remotely.
"If someone bumps their head skiing at Stowe, and you're not sure how serious the injury is, traditionally you throw them in an ambulance and drive them to Burlington, which is expensive," says Seth Nichols. "You can use telemedicine to look at the head, to do an x-ray, and say 'yes it's serious, send them up' or 'no, it's not, take two aspirin.' The goal is to provide the highest-quality care in the most efficient manner."
Being able to record these sessions and store the information in relational databases is crucial for record keeping and later analysis, integrators say. System Concepts Associates sells a telemedicine Pentium PC with software that can record verbal comments, heartbeats, and images, saving them in a Watcom database so they can be accessed or augmented later according to the patient's or doctor's name.
Integrators may be surprised to
learn of such cutting-edge projects in health care. Historically, this industry has been slower to computerize than others. That's partly because of the multimedia nature of its data, which requires more expensive and advanced technology than, say, the numerical information that's bandied between banks. Health-care companies are also under pressure to save money, not spend it. However, if a technology can be shown to cut costs and deliver better care at the same time, health-care providers will chart their course right to it.
Where to Find
Cambridge Technology Partners, Inc.
Cambridge, MA
Phone: 617-374-9800
Fax: 617-374-8300
Internet:
http://www.ctp.com
Cutting-Edge Health Care
