Using the Web to extend patient care

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June 2, 2000
Web posted at: 10:21 a.m. EDT (1421 GMT)

by Jason Meserve

(IDG) -- The task of tying multiple legacy systems together to give doctors a single point of access to more than one million patient records was at the core of a merger between Beth Israel and Deaconess hospitals in Boston.

The two facilities - located only a block from each other - had separate mainframes that stored each hospital's clinical patient data. There were no means of accessing records from each hospital from a single interface.

Add on top of that the four other hospitals that belonged to the newly formed CareGroup Healthcare System and the countless physicians who wanted access from outside their hospitals' walls and you have a data-access nightmare.

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That was 18 months ago, before CareGroup became acclimated to the Web, thanks in part to Dr. John Halamka, chief medical information officer for the organization. Halamka took his position about a month after the project to integrate access to the various information systems got under way and knew the Web, rather than a client/ server approach, was the way to go.

"Eighteen months ago, we had no Web. Now everything is Web," Halamka says. "Our workstations that used to be client/server are now basically Internet Explorer 5."

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Halamka figured the thin-client Web approach was much better than trying to push software updates to CareGroup's 7,000 desktops. Fortunately for Halamka and his staff of six programmers, each legacy system that needed to be integrated uses or interacts with InterSystems' Cache hierarchical database. This allowed all the data to be wrapped in XML and shared across the network, while keeping the individual systems in place. Halamka says some systems were retired or streamlined during the preparation for the millennium.

Using a hierarchical database for medical records is a much better option than a typical relational database, Halamka says, because each patient might have three tests, and each test may have seven components. This is more efficient in a hierarchy than in rows and columns.

The resulting CareWeb system now lets CareGroup's 3,000 doctors and 12,000 employees access patient data from just about anywhere. Records from each of the hospitals have been cross-referenced, making it easier for doctors to find information on the John Smith that checked into Mt. Auburn Hospital and the same John Q. Smith who was treated at Beth Israel Deaconess. Not only can the data be accessed from inside the hospital, but physicians can also get the information from remote locations using Cisco's Altiga virtual private network software, SecureID encryption and Secure Sockets Layer technology.

CareWeb includes homegrown portal technology for customizing its look and feel for individuals, and can be used by patients to access their medical records and check for drug interactions. Soon the site will let CareGroup patients pay their doctor bills online.

Employees can use the portal as well to check lunch menus, share bulletin board information and look up other hospital-related data. CareGroup even pulls insurance information from its partners to save employees and patients time when forms need to be completed.

Not only has the data access been simplified, so has the network, which was previously made up of a mix of Cisco and Cabletron equipment but now comprises all Cisco gear. A data center is connected to three of the hospitals, including the main campus, via a Bell Atlantic SONET ring. The rest of the hospitals are connected via T-3 lines.

The entire network has been built to allow for a maximum of three minutes of unexpected downtime per year, Halamka says.

To make sure all the systems work, Halamka tests them himself. Every Friday night, the doctor spends eight hours working in Beth Israel Deaconess emergency room treating critical patients.

"I have to use all my Web applications," Halamka says of his double duty as coder and doctor.

But what happens if the network goes down while he's working on a patient? "I am paged for IS-related items when doing patient care. However, patient care always comes first," he says.

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