High-tech healthcare

Thursday Jun 1st 2000 by Amanda Mitchell Henry
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Multihospital intranet helps keep patients, providers, and payers in touch with medical information.


At a Glance

CareGroup Healthcare System

The company: Boston-based CareGroup Healthcare System includes six hospitals, 2,500 providers, and 800,000 patients in the Northeastern United States.

The problem: CareGroup needed to deliver better care for patients at a lower cost to the organization.

The solution: The CareWeb intranet system consolidates medical records from geographically dispersed patients into a single clinical database accessible via a Web browser.

The IT infrastructure: Windows NT is the main platform for Exchange 5.5 mail servers, Internet Information Server (IIS) 4.0 Web servers, SQL Server 7.0 servers for storing financial transactional data, and InterSystems' CACHI e-DBMS software. CareGroup also runs several redundant back-up servers and UNIX application servers for back-end applications.
Most people appreciate the Internet's instant delivery of stock quotes, weather reports, and international news. But few realize Web access may have life-saving potential.

Instant access to patients' medical histories is letting doctors diagnose and treat people more quickly thanks to an intranet called CareWeb. The Web-based medical information system was created by CareGroup Healthcare System as the antidote for elevating the level of patient care, while at the same time, lowering operational costs. The system was first introduced in 1998. Most recently, in April, CareGroup rolled out the Secure Patient/Physician Communication application, a database of clinical information, which currently has about 250 users.

"With our clinical systems on the Web, if I am an E.R. doctor and a 53-year-old patient rolls in with chest pain I am able to compare that day's events with what happened [to him] a year ago," says Dr. John Halamka, CIO of CareGroup, in Boston.

CareGroup officials say the system has proven its merit by increasing the level of patient care while reducing expenses. "Without a doubt, the quality of care that we deliver to patients has improved, and the stress level has decreased," says Dr. David Sands, a CareGroup physician as well as a Boston-based CareWeb user. CareWeb saves the organization about $1 million annually, CareGroup officials say. It is this type of savings that will prompt the deployment of more CareWeb-type intranets down the road, notes Carl Olofson, program director at International Data Corp. (IDC) in Framingham Mass.

While hospitals are often on the leading edge of medical technology, they aren't known for breaking new ground in information technology. But the relatively low cost of intranet systems for streamlining data is giving healthcare organizations an affordable means of achieving a competitive edge in the way business is conducted as well as the way their patients are treated.

John Halamka, CIO, says CareGroup changed from a paper-based to a Web-enabled process with very little money invested.

Benefits abound

CareWeb replaces a cumbersome paper-based medical information retrieval system. Now, finding information is a matter of typing the right commands into a computer. The intranet puts patients' medical histories at physicians' browser-enabled fingertips. Information such as allergies, medications used, and surgeries a patient has had, are all available.

Access to CareWeb is not limited to physicians and nurses. Patients have quick and easy online access to their own medical information. They can also fill prescriptions and request referrals. Users simply need a browser and a password, which is provided by CareWeb, to access the intranet.

The idea behind CareWeb is to create an environment in which doctors provide better care for patients--even if they have never seen them before--because all patient history information is readily available. "We started sharing information across the network so that whether patients go downtown or to a community hospital, all of their information is available to doctors," explains Halamka, in Cambridge, Mass. The new Secure Patient/Physician Communication application secures all information via 128-bit secure sockets layer (SSL) encryption. Full auditing and special commands in Web pages prevent users from caching in the browser.

CareWeb doesn't overlook insurance providers, either. For example, one application gives insurance providers in Massachusetts access to CareWeb so that insurance transactions can be conducted over the Web. CareGroup has interfaced to Harvard Pilgrim Health Care, Medicaid, Medicare, and Tufts Health Plan, and it is actively pursuing a relationship with Blue Cross and Blue Shield of Massachusetts. Currently, insurance providers can transmit information on benefits and eligibility, and CareGroup will have referral and authorization applications later this month. By the end of 2000, it will be possible to submit claims over CareWeb.

Because key patient data-such as eligibility, date of birth, address, and age-are all recorded in a single database that is shared between CareGroup and insurance providers, both parties have identical patient information. The intranet helps eliminate costly mistakes; information does not need to be reentered each time a claim is filed. According to Halamka, the cost in payment denials resulting from mismatched patient data has already been reduced from $8 million to $6 million.

What makes CareWeb tick

CareGroup includes six hospitals, 2,500 providers, and 800,000 patients in the Northeastern United States. The CareWeb system consolidates medical records from geographically dispersed patients into a single clinical database accessible via a browser. As many as 12,000 end users--including doctors, nurses, technicians, lab staff, patients, and insurance companies--currently access CareWeb.

What to do when planning an intranet information exchange
1.

Deploy the intranet incrementally.

2.

Go for quick wins, such as office supply ordering.

3.

Constantly evaluate Web applications to stay current.

4.

Be aware that the process and the change management are more important than the technology.

5.

Remember that security and confidentiality are of paramount importance.

The intranet's infrastructure relies primarily on Microsoft Corp. technology: Windows NT is the platform for its fleet of 173 servers. Included in the mix are Microsoft Exchange 5.5 mail servers; Microsoft Internet Information Server (IIS) 4.0 Web servers; Microsoft SQL Server 7.0 servers for storing financial transactional data; and InterSystems Corp.'s CACHI e-DBMS software, the primary database repository for all of the clinical systems.

CareGroup chose the CACHI product for hosting clinical data because medical information lends itself to a hierarchical rather than relational database structure. "Patients have labs and they are not interrelated," says Halamka. "The patient is at the top of the tree, and all labs are leaves in the tree, so if you use a hierarchical database, it's really fast." As much as 90GB worth of clinical data is housed in the intranet database.

That amount of data is not surprising: There is a computer in every exam room, in hallways, "everywhere you turn, so that wherever you happen to take care of a patient, information is available to you. We can provide prescriptions more carefully [and] more legibly, and CareWeb helps providers keep track of the patient's problem list," says Sands. He describes treating one patient who complained of unusual symptoms. Rather than shuffling through paper charts, Sands looked up the patient's history and quickly diagnosed and solved the problem.

Physicians can also log on remotely; CareWeb uses RSA Security Inc.'s RSA SecureID technology, which maintains secure authorization through continually changing passwords. "Let's say I'm at home and I get a call from the lab saying that somebody's blood count was 17. In the old days, I would have been stuck with no access to patient information," says Dr. Richard Parker, another Boston-based CareGroup physician. "Now I am able to go into my computer at home, link into the system at work, pull up information, understand all of the patient's problems, and know exactly what to do."

CareWeb also includes a handful of redundant back-up servers as well as Hewlett-Packard Co. HP/UX UNIX application servers for running back-end applications. For purposes of server maintenance, CareWeb uses a Cisco Systems Inc. virtual private network (VPN); if a server goes down, administrators can access and repair the faulty system remotely.

Another high-tech healthcare org

In a similar example of high-tech healthcare, Partners HealthCare Systems Inc., a multibillion-dollar integrated healthcare delivery system headquartered in Boston, is using the Web to deliver information more easily and quickly to thousands of physicians in its network. Partners HealthCare created the Partners Phone Directory (PPD), a collection of hospital directories and paging systems from hospitals in its network. The intranet offers e-mail connectivity, Web-based group paging, clinical system alerting, on-call schedules, and an operator answering service.

Currently, there are about 300 different applications available on CareWeb, and every day new ideas are evaluated for expansion, or reduction when applications are no longer necessary. In addition to forums for patients and insurance providers, CareWeb's applications include medical(such as one used for calculating kidney functions), financial, and even a signature authorization program.

Evaluating the bottom line

There are several ways CareGroup saves money through its Web-based medical information system. The organization is able to reduce administrative expenses in areas such as clinician search time, patient admittance processing time, and training time. For example, CareGroup has eliminated the expense of pulling paper-based charts; retrieving a file from a records department costs between $4 and $5, according to Halamka. He also estimates insurance transactions conducted over CareWeb are reduced from $7 to 10 cents per item because the administrative overhead is reduced.

"Even with all of their volume and specialized data management needs, hospitals have been somewhat neglected in the computer business because they are not seen as something where you can derive high profit margins. They are not in a position at any given point to make a large investment in technology," says IDC's Olofson. "But newer, Internet standards-based technology enables hospitals to establish connectivity and better database management without major investment."

Halamka estimates approximately $250,000 was spent on deploying the intranet, including hardware, software, and training. "Certainly, the amount of economy we can achieve [through CareWeb] is better," he says. "But even more than that, we have changed from a paper-based process to a Web-enabled process with very little money invested."

CareWeb also offers CareGroup the opportunity to make money: Halamka predicts an annual revenue increase of $3 million to $4 million based on new business opportunities created by the firm's e-business approach to managed healthcare. Halamka is hoping to attract new patients and retain existing ones through the convenience of Web technology. He also is expecting fewer referrals to non-CareGroup providers, since CareWeb's secure messaging emphasizes communication among CareGroup providers and patients. "Every aspect of our business depends on the Web; we are now 100% Web-enabled, he says." //

Amanda Mitchell Henry has been writing about business and technology for 10 years. She can be reached at amandamh@tstt.net.tt.

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