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Healthcare's last mile: linking disparate information systems. (Viewpoint).

In the telecommunications industry, the "last mile" is the cable linking the technology infrastructure of the switching station to the consumer sitting at home. One of the reasons for this industry's recent collapse was that it made a massive expense on the underlying infrastructure, yet failed to reach and impact consumers with real value. It failed to go the last mile.

We are facing a similar situation in healthcare. Healthcare organizations have spent billions in recent years on information technology, but we still are not having a sufficient impact on patients and the quality of care they receive. We have not gone the last mile. The reason: a myriad of disparate systems that cannot talk to each other. Too often, the information is stored in Silos, legacy systems unable to talk to each other.

For example, we have seen tremendous improvements in the capabilities of clinical information systems used within health plans. Artificial intelligencetools, such as logic engines and neural networks neural network or neural computing, computer architecture modeled upon the human brain's interconnected system of neurons. Neural networks imitate the brain's ability to sort out patterns and learn from trial and error, discerning and extracting , enable disease management programs to look at comorbidities, services and medications and to differentiate between high-, moderate-and low-risk patients. The technology is impressive, but it is still far from reaching its full potential because of limitations in how the implications of such analyses are communicated to the patients, their families and their physicians.

To allow technology to "go the last mile," healthcare IT systems need to reach the point of care, intelligently integrate the myriad of available information sources and be easier to use.

Lack of Integration

In recent years, we have brought IT closer to the point of care. A small but growing number of physicians use PDAs that allow them to take advantage of computerized physician order entry technology. A typical application is prescription ordering. By using the PDA (Personal Digital Assistant) A handheld computer for managing contacts, appointments and tasks. It typically includes a name and address database, calendar, to-do list and note taker, which are the functions in a personal information manager (see PIM). , the physician can check on the dosage dosage /dos·age/ (do´saj) the determination and regulation of the size, frequency, and number of doses.

1. Administration of a therapeutic agent in prescribed amounts.
 level and possible drug interactions. However, in most cases, the PDA's software provides a limited set of functions. For instance, it is not able to interact intelligently with the patient's medical record or care management information used by his health plan.

We need to take this technology to the next level. A physician should be able to carry on an unobtrusive "conversation" with a centralized cen·tral·ize  
v. cen·tral·ized, cen·tral·iz·ing, cen·tral·iz·es
1. To draw into or toward a center; consolidate.

 clinical information system while he is still in the room with the patient. The physician might, for example, enter key signs and symptoms into his PDA, connected by wireless network to the clinical information system. The system would respond within seconds by showing relevant highlights of the patient's medical record, possible diagnoses and clinical pathway clinical pathway Critical pathway, treatment pathway Clinical medicine A standardized algorithm of a consensus of the best way to manage a particular condition Modalities used Teletherapy, brachytherapy, hyperthermia and stereotactic radiation.  suggestions that take into account the patient's clinical history.

The primary obstacle now is the lack of overall integration across our diverse healthcare institutions and within individual organizations. To date, healthcare technology solutions have targeted hundreds of narrow areas and problems. This approach has created information silos An information silo is a management system incapable of reciprocal operation with other, related management systems. A bank's management system, for example, is considered a silo if it cannot exchange information with other related systems within its own organization, or with the  and prevented health plans, specialty organizations and others from accessing needed information on a timely basis and improving the quality of care.

Opening Doors

Two key technological developments may open the door for rapid adoption of new clinical information systems and advanced medical devices. One is the growing use of the Internet as a low-cost communications channel Also called a "circuit" or "line," it is a pathway over which data are transferred between remote devices. It may refer to the entire physical medium, such as a telephone line, optical fiber, coaxial cable or twisted wire pair, or, it may refer to one of several carrier frequencies  and of Web services (1) Loosely, any online service delivered over the Web. Such usage appears in articles from non-technical sources, but not in IT-oriented publications, because definition #2 below describes the correct use of the term.  as a cross-technology integration methodology.

Web services provide a standardized approach According to International Convergence of Capital Measurement and Capital Standards, known as Basel II, the standardized approach is a set of risk measurement techniques for banking institutions. The term may be used in the context of credit risk or operational risk.  for publishing and accessing services and information via internal and external networks. They provide technical standards that enable disparate computer technologies to connect seamlessly with legacy systems and different business functions. They also enable internal networks to communicate on a secure basis with outside organizations and individuals.

For example, MEDecision's iEXCHANGE[TM] system uses Web services technology to integrate functions provided by interactive voice technology, electronic data interchange See EDI.

(application, communications) electronic data interchange - (EDI) The exchange of standardised document forms between computer systems for business use. EDI is part of electronic commerce.
 and Web-based applications See Web application.  available over the Internet. This allows health plans to collect and share with physicians the information obtained from members, hospitals and other physicians over the telephone and the Internet from a centrally located information base. The system supports the processing of referrals and authorizations as its core financial justification, but it can also link medical management software with various databases, enabling the clinical and financial assessment of care management alternatives.

In addition to making information more accessible, we need to make it easier to use. On average, a physician spends less than 12 minutes with a patient in his office. A physician cannot spend 10 of those minutes scrolling (chat, games) scrolling - To flood a chat room or Internet game with text or macros in an attempt to annoy the occupants. This can often cause the chat room to be "uninhabitable" due to the "noise" created by the scroller. Compare spam.  through pages of journal articles. The correct information must be presented in a single view. Software must have intuitive, interactive capabilities, allowing a physician or nurse to make queries and receive immediate responses.

In the coming years, we will see the increasing use of electronic medical records and transmission of data by home monitoring and implantable or wearable medical devices. The new data sources, when coupled with new types of analytical software Analytical software is software that is designed specifically for and development of a particular environment or object. , have the potential to reshape the way we deliver healthcare in the U.S.

Clinicians will be able to download information from instruments implanted im·plant  
v. im·plant·ed, im·plant·ing, im·plants
1. To set in firmly, as into the ground: implant fence posts.

 in patients and have the data analyzed by a decision support system using artificial intelligence tools, such as logic engines and neural networks. The physician can then communicate care instructions to the patient, even if he is confined con·fine  
v. con·fined, con·fin·ing, con·fines
1. To keep within bounds; restrict: Please confine your remarks to the issues at hand. See Synonyms at limit.
 to his home or at a remote clinic.

How soon can we achieve this vision? It's hard to say, but health plans, physicians and policymakers need to work together to make it a reality. Our nation's healthcare system is facing a cost crisis. Our population is aging, costs are rising at double-digit rates, and nurses and physicians are frustrated frus·trate  
tr.v. frus·trat·ed, frus·trat·ing, frus·trates
a. To prevent from accomplishing a purpose or fulfilling a desire; thwart:
 with an unending stream of paperwork. We need to "go the last mile," to transform our healthcare information system into a workable tool that eases workflow and improves patient care.

David St. Clair is chief executive officer of MEDecision, a medical management software company in Wayne, PA.
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Author:St. Clair, David
Publication:Health Management Technology
Article Type:Industry Overview
Geographic Code:1USA
Date:Feb 1, 2003
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