Medical intranets: new technologies expose old problems

Healthcare Financial Management, March, 1998 by Edward Fotsch

Although medical intranets can provide substantial value in

delivering clinical and administrative data to inpatient and outpatient

settings, their effectiveness can be significantly diminished if certain

information technology (IT) issues are not addressed.(a) These issues, many

of which existed long before the advent of Internet-based communications,

involve technical, political, and practical considerations and can

influence the functionality, performance, and scope of Internet-based

provider networks. They even can undermine an organization's attempts to

implement such networks.

Creating a Data Repository

Assuming that one of the principal reasons for implementing an intranet is

to deliver clinical data from various disparate sources (eg, inpatient and

outpatient laboratories, radiology, department and transcription services),

an important technical issue to be addressed is the creation of a clinical

data repository for data aggregation. This repository should be accessible

from all points within the healthcare system, thereby providing all network

users with a single source of data for each patient or provider. Moreover,

the security model, user interface, and means of navigating the repository

should be standardized across the network. Establishing systemwide access to

an efficient and easy-to-use data resource is especially important in the

outpatient setting, such as physician offices with limited administrative

staff, inadequate IT training, and substantial staff turnover.

Creating a data repository brings with it several technical challenges,

however, that need to be addressed if the repository and the network are to

function successfully. First, because few organizations' existing systems

are connected to networks that can be accessed concurrently by multiple

remote users, such interfaces usually need to be established. Although

interface engines available in the marketplace can partially address this

issue, integrating the data repository with legacy applications remains a

labor- and resource-intensive process.

The next challenge is to ensure that the data repository will appropriately

manage the discrete clinical data from numerous systems and allow them to

remain associated with the correct patients and their associated providers

as the data are merged and consolidated into the repository. Herein lies the

need for a single common identifier for each patient, commonly referred to

as a master patient index (MPI). Without an MPI, the challenge of collecting

and storing data and delivering these data quickly and reliably from

multiple clinical sources to multiple recipients can become insurmountable.

Interestingly, some organizations instituted clinical data repositories,

with interfaces to existing systems and a robust MPI, long before they

considered implementing medical intranets. Yet, for many organizations,

these technical issues have come to the forefront only recently as a result

of investigations related to the use of intranets to provide network access

across the care continuum.

Data Security

The collection, storage, and delivery of patient-specific clinical data also

carry the responsibility, both legally and ethically, to ensure appropriate

network security. The issue of Internet-based network security has been

addressed in past columns, as well as in hundreds of articles and

publications on information technology. Regulations related to computer and

network security for patient-specific clinical data are proliferating on

state and Federal levels. The fact that these regulations apply to

intranets, as well as to existing computers and networks, often is

overlooked.

Political and Financial Factors

Another issue brought into focus by medical intranets relates to the

political realities of cooperation and collaboration within and among

healthcare organizations. The effectiveness of a medical intranet will be

limited by the ability of the various custodians of multiple disparate data

sources and network services to collaborate and coordinate their activities.

Issues of control, budgets, and responsibilities can delay the delivery of

intranet services. In the worst case, in-fighting can derail the entire

network. Struggles between the IT department, which traditionally is

responsible for inpatient IT network operations, and marketing, medical

staff, and physician relations departments, therefore, must be minimized. To

reduce conflict and engender a more cooperative environment, the IT

department should be assigned responsibility for delivering and maintaining

the network, while the other departments should retain responsibility for

providing and updating content and services.

Conclusion

Ultimately, for medical intranets to deliver value by providing information

from numerous sources that may be loosely affiliated, at best, a shared

vision for the network needs to be developed. Although coordination is

relatively simple to envision and prescribe at a high level, executing it