Coming Attractions.

The burst of new technology developments in e-commerce, medical informatics, wireless communications and Application Service Providers (ASPs) will clearly influence and change all types of healthcare far into the future. Although technology continues to develop at an exponential rate, many, if not most, long-term care providers have been relatively slow to adopt emerging technologies, partly because many are incomplete, but often because of the expense involved in replacing older technology. However, the capability of new technology to increase efficiency, reduce costs and improve delivery of care is so significant that long-term care providers will, of necessity, soon adopt many of the innovations.

This column initiates a series of reports on new technology developments and their implications for long-term care providers. The series begins with an overview of major technology trends in healthcare. In later articles, some of the key technology trends affecting long-term care providers will be explored and evaluated in detail.

Although there is no way to continuously monitor and report all the new technologic developments affecting healthcare delivery, the most important trends for long-term care providers are:

1. ASPs and the Internet

Although ASP development is in its early stages, renting software applications is one of the most cost-effective ways to process, analyze and store information. All types of applications (financial, clinical, human resources, purchasing, etc.) can be accessed either on an ASP Web site or downloaded from an ASP and used at a facility or organization to process data. Using an ASP does not require any major information-services staffing, and it eliminates the high costs of maintaining a communications infrastructure. Moreover, many ASPs offer access to multiple software applications, as well as executive information reporting that can be customized to meet providers' requirements.

There are many models of ASPs, some involving both on-site client-server methods and off-site virtual private network servers used for certain functions. The key features of an ASP include:

* cost-effectiveness--monthly fees and no large up-front payment

* rapid implementation

* continuous improvements and upgrades, with no requirements for purchasing new products or using extra installation and support resources

One of the most comprehensive information sources on ASPs is webharbor.com. Although ASPs are a recommended alternative for long-term care providers, caution should be used in evaluating this option, because few vendors have full ASP functionality at present. As with most information technology, making an investment in carefully evaluating products and matching them to organizational requirements results in the best purchasing decisions with the greatest long-term benefit for the organization.

2. Electronic procurement and supply using Web technology

Electronic procurement technology is already enabling many providers to completely avoid using paper catalogs and purchase orders by using Web-enabled purchasing systems that provide up-to-date products, discount pricing and order-processing efficiency. Often, electronic procurement systems completely pay for themselves in less than three years, and they provide much greater product diversification and very competitive pricing. In some cases, medical suppliers are offering customers discounted hardware and software to attract them to their e-commerce purchasing applications. Web-based purchasing systems are quickly overcoming the high costs of electronic data interchange (EDI) networks and offer large, competitive purchasing advantages to smaller organizations.

There are many options for electronic procurement continually becoming available. These include major software vendors such as PeopleSoft and SAP America, Inc., as well as business-to-business e-commerce vendors focused on the healthcare market.

Information on electronic purchasing is available from Promedix.com, Medicalbuyer.com, Omnicell.com and Neoforma.com. Also, a number of medical purchasing cooperatives have been formed to use e-commerce technology. Participation in such cooperatives can be an efficient approach for long-term care providers.

3. Wireless networks and mobile caregivers

It is clear that improvements in wireless technology now make it possible to increase the mobility of caregivers documenting treatment and using information throughout the facility. Wireless technology can also be used to transmit charges directly to patient accounts for billing and claims submission. Using wireless technology, information can also go directly to a patient's electronic medical record, enabling real-time patient management. Multiple wireless devices (personal digital assistants [PDAs], notebook computers, medical technology recording devices, etc.) can now all be used on facility-wide wireless networks. Faster wireless data transmission speeds can now provide information to multiple users simultaneously, including access to patient data on Web sites through local area networks.

In addition to internal facility wireless communications, this technology can also be used for patient monitoring at home or in other living settings, and data can be transmitted back to the treating office or facility using the Internet. Higher data transmission rates will soon enable use of voice and graphical applications on wireless networks, enabling treatment staff to review data/graphics on notebook or other portable devices.

A major issue in wireless applications remains proprietary technology, which precludes use of multiple devices and systems from different manufacturers. This issue is now being addressed, and an open architecture standard will likely be the end result.

Use of wireless technology does require significant investment by providers. But the efficiencies gained on data capture, transmission and cost-effective treatment warrant evaluation of this technology by providers with larger numbers of beds and multiple venues of care. Also, providers who expect to use Web-based applications for providing patient information to family members (including video and audio access) could also consider wireless applications.

4. New communication technologies improving quality and efficiency of care

New developments in communications technology are already leading to improved workflow, data collection and data-access efficiency and improved quality of care in the institutions that employ them. The most recent developments include:

* speech recognition, optical character recognition, touch screens and multimedia technologies (linking data, voice and video)

* voice commands to update patient records at the point-of-care and "write" electronic prescriptions, orders for tests, etc.

* interactive patient and family education programs customized for individual needs based on disease/impairment, risk profiles and individual learning capability

Indeed, speech-recognition technology has improved considerably and is now being used for documenting patient treatment, operating medical equipment, automated real-time language translation and interactive voice-response systems (IVR) that automatically provide answers to frequently asked patient questions. Interactive voice-response systems are already beginning to be offered as online Web-based products.

Intelligent and optical character recognition systems are now available that can recognize hand-printed documents and convert them to text very rapidly. This technology also converts printed documents into electronic files, including forms, spreadsheets and even complex designs. The technology can also "convert" paper documents into electronic code for use on Web sites.

Finally, touch screens--long used in the financial and retail industries--are now being used both at the point-of-care and as devices to enable better patient education through video and audio informational presentations tailored to individual patient needs.

All of these technologies will enable breaking away from total dependence on personal computers, increase caregiver mobility, increase workflow efficiency and significantly improve the efficiency of e-business applications. While long-term care providers might want to selectively adopt these new communications technologies based on the amount of efficiency to be gained, they should consider these options as part of an overall strategy to improve information technology.

5. The farther shore: Artificial intelligence applications

The growth of e-commerce is leading to significantly greater use of artificial intelligence and expert systems technologies. These types of applications can be expected to grow significantly in the future, because they can be used to reduce costs and improve the efficiency of treatment.

Artificial intelligence is used to identify patterns and deviations in data and to develop statistical rules ("expert systems") that can be applied to specialized situations. These often involve prediction tools, which can, for example, detect patterns of medical errors, predict the expense of individual patient care and identify claims errors. Expert systems can be used to improve diagnostic evaluations and treatment protocol choices, identify low-cost purchasing patterns and locate information customized to particular patient conditions.

New uses of artificial intelligence involve developing programs (known as "bots") that automate the purchase of pharmaceuticals and medical supplies, predict product shortages or oversupply, manage product inventory shelf-life and "negotiate" purchases as prices change. Other uses, now under development, include automating credentialing, medical treatment guidelines, disease management protocols, fraud detection and prediction, billing and payment transaction analysis, and credit analysis.

The extent to which all of these and other new technologies will be used by long-term care providers depends on their willingness to examine and change business and clinical treatment processes and evaluate how use of technology can produce significant efficiencies and reduce costs. While new technology often requires an investment, the returns in terms of reduced costs and greater efficiency often far exceed the investment within a relatively short time. Technology innovations cannot solve all problems, but their use can produce efficiency in many essential business operations and improve the quality and cost-effectiveness of care.

Malcolm H. Morrison, PhD, is president and CEO of Morrison Informatics, Inc., a healthcare information-technology consulting company specializing in post-acute care. For more information, e-mail [e-mail].