ASPs: A Better Tool - Industry Trend or Event

Health Management Technology, Jan, 2001 by John Jr. Dwyer

A glimpse into the future of managed care.

It is any patient's worst nightmare and, for a few stressful days, was a very real nightmare for my family and me.

My mother went to the dentist for a routine check-up. Several days later, she developed a low-grade fever and persistent malaise. What we thought was a garden-variety case of the flu turned out to be an infected heart valve--a condition that nearly cost my mother her life. She was admitted to the hospital and underwent a $40,000 emergency heart valve replacement.

How could a simple trip to the dentist turn in to a medical nightmare? During my mother's tooth cleaning, bacteria entered her bloodstream. She had recently undergone chemotherapy, weakening her autoimmune system and rendering the bacteria deadly.

This disaster could have been prevented with penicillin, had the dentist seen a complete profile of my mother's health situation before the cleaning took place.

Technology to the Rescue--Literally

IT decision-makers in managed care know that technology makes it possible to consolidate a patient's medical information in one central location, preventing costly and potentially deadly medical errors such as these. Not only is patient information collected in one place, the right technology tool can generate intelligent recommendations such as warning of harmful drug interactions, adverse indicators, etc. The algorithms that generate these recommendations become increasingly intelligent over time as they are fed new patient information and as advances in medicine emerge.

Until recently, patient databases were typically managed using a client/server model. Patient health information was only stored on workstations, or servers, and accessible from computers connected to those workstations (clients). But this approach carries shortcomings. For instance, any time a piece of information is changed in the client/server model, installation disks must distributed manually, a costly and time-consuming process.

Internet-based Approach

Application Server Providers (ASPs) offer the benefits of a client/server model with numerous additional advantages. Rather than requiring manual data updates, an ASP allows updates and software upgrades to be instantly downloaded from the Internet. With the ability to transfer information digitally, there's no need for a patient to fill out a form only to have a medical secretary transcribe it later. And as new drugs are developed and as new medical discoveries are made, updates can be immediately incorporated into a patient's medical history.

New drug information is emerging at an incredibly fast rate, even with well-known drugs. The instantaneous updates that an ASP model provides can be a matter of life and death. A recent example: The FDA-approved drug Propulsid is commonly used to treat stomach acid problems. But doctors independently noticed that some patients who used the drug experienced heart problems. Researchers later determined that Propulsid could cause cardiac arrest in patients with arrhythmia.

In a client/server environment, alerting patients with Propulsid prescriptions to this contraindication would be a logistical nightmare. With an ASP, patients can be alerted immediately and simultaneously with a single e-mail; moreover, the subset of those patients with arrhythmia can be alerted with a "Please call your doctor immediately" message via their pager, voice mail or mode of their choice. ASPs prevent the "miscategorization" of patients by taking into account the entire picture, prescribed drugs, procedures and lab test results, as well as patient variables such as age and gender--not just a particular diagnosis.

From the managed care organization's perspective, one of the most obvious and immediate benefits of the ASP approach is that it minimizes capital expenditure, both initially and as the application is updated. Beyond the cost of the software itself, the client/server approach requires individual licenses for each client--a set-up that can become costly very quickly. With an ASP, the organization pays per use, meaning lower cost per user.

Another benefit is that ASPs improve resource allocation. This is particularly important in light of today's IT staffing shortage, when it is not always feasible to have dedicated staff managing and updating client-side records. In addition, medical data becomes completely portable, a critical advantage when labs, hospitals and doctors are often distributed, literally, all over the map for a single patient.

Finally, an ASP approach generates better workflow efficiency. Case management, disease management and other work/low processes can be easily delivered from ASP architecture, allowing doctors and nurses to do their jobs more efficiently. Recently, a practicing endocrinologist in St. Louis, MO, deployed a managed care product that enables his patients to enter their daily blood glucose levels, exercise and diet into a safe and secure Web site. This enables him or a member of his staff to check in on his patients and monitor their diabetes on a day-by-day basis. This greatly streamlines the patient care process while managing work/low more efficiently and effectively.