Monday, October 09, 2006

Are We Close to Real Data Integration

Are We Close to Real Data Integration 'Redefining Healthcare'?

Michael Porter and Elizabeth Teisberg in their book Redefining Healthcare tout the concept of hospitals competing over excellence in treating specific medical conditions nationally. The Cleveland Clinic, among others, is marketing its online second opinion service. Technology vendors such as Sun ("services-oriented architecture"), Cisco ("application-oriented networks"), and Microsoft -- which just acquired interface technology company Azyxxi -- are all narrowing in on the problem of information exchange between existing clinical and operational systems. The PACS market is growing fast, and the amount spent on medical imaging is growing faster. Meanwhile, physician shortages in rural areas mean that hospitals are outsourcing radiology to larger regional, national, and even international players.

This all sounds like the perfect environment to share information regionally. There's just one tiny problem. The average CIO is already minding more than a hundred interfaces between systems, and the concept of having to extend that management beyond the bounds of the institution is frightening -- and a major stumbling block in front of the RHIOs.

What's needed is an easy way of extracting and exchanging clinical data in its context. Companies such as TeraMedica and Philips (via its acquisition of Stentor) are all working with brand-name clients to achieve this, but some of the boldest claims being made come from a small company called CMTC. CEO Shimon Schurr says, "The concepts that RHIOs are in policy discussions about for the future, our technology can do today." For example, CMTC can take clinical data from a variety of system, allow it to be put on a secure Web site and have it uploaded into a completely different system (e.g., PACS and EMR), including keeping the surrounding workflow information and patient context. Adding videoconferencing and this creates an online workspace for consults.

Schurr says that at the core of CMTC's .NET-based technology is a concept called Semantic Interoperability, which essentially allows data to be automatically normalized and exchanged between systems. Thus far, it's been used for remote consultation between New York Presbyterian Hospital and medical centers in Turkey and Israel. In conjunction with Kodak and Accenture, University of Virginia Medical Center will soon start testing the system with community oncologists and regional hospitals.

If the Porter/Teisberg concept is to succeed, for technology to bring the expertise of centers of excellence virtually to patients in any setting requires an easy, secure method of combining patient records, workflow information, images, and conferencing technologies online. Then remote physicians or teams of clinicians can view it at one time (or asynchronously) without new interfaces or expensive infrastructure. The promise is a real "dislocation" of the workflow for how diagnoses are currently managed. Possibly using technology like CMTC's, that promise could become reality sooner rather than in some pie-in-the-sky futures.


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