By Michael Cohen
The Internet/intranet is impacting the way businesses function and the health care industry is no exception to this revolution. Medical practices are beginning to experience how this new vehicle for exchanging information can benefit them. Historically, one of the criticisms of the health care industry has been the inefficiencies and cost redundancies caused by the inability to share information. The practical advantages of the Internet/intranet help resolve many of the connectivity and cost problems that have hindered these efforts to make systems inter-operable and to automate and seamlessly exchange data. Internet/intranet technologies offer new capabilities to the health care industry due to their ease of use, platform independence and inexpensive connectivity. Taking advantage of these evolving capabilities can help lower costs, improve patient/member service and assist in the delivery of better-coordinated care.
Physicians, traditionally slow adopters of technology, have embraced the Internet and online services. The Internet Survey of Medicine was recently released and revealed that 85 percent of physicians surveyed are currently using the Internet. More than 63 percent of the physicians surveyed use e-mail daily and 33 percent use the e-mail to communicate with patients. The survey also stated that security remains the primary concern in the use of e-mail and interactive Internet/intranet services.
The Internet and intranet utilize similar technologies and offer similar functionality, but they differ in application.
The Internet is a worldwide system of computer networks. Users at any one computer can, if they have permission, get information from any other computer. Often this information is found at web sites or home pages presenting information about a company, topic, person, etc.
An intranet is a network or networks contained within an organization. Typically, an intranet includes the ability to access the public Internet through firewall servers that have the functionality to screen messages in both directions so that company security is preserved. The main purpose of an intranet is to share/exchange information and computing resources among members of an organization.
An intranet uses Internet protocols like TCP/IP, HTTP and, in general, looks like a private version of the Internet. When part of an intranet is made accessible to physicians, suppliers or others outside the practice, that part is called an extranet.
Integration into Medical Practices
Physicians are only beginning to integrate the Internet/intranet into their medical practices. The type of information and functionality that is being Internet/intranet enabled can be grouped into four progressive phases based upon technical requirements and business impact. The capabilities and functionality described in the phases move from the presentation of static information in Phase I to providing transactional services with integrated processing in Phase IV.
Phase I: Static Content
Most practices’ initial usage of the Internet/intranet is to serve as a new vehicle for distributing information. Like early websites, users click on icons or search for information that brings up additional documents. The documents are static, meaning they can not be revised, except by a webmaster on the central repository. This offers practices another vehicle for disseminating information, but not for exchanging information.
The content is often information that has historically been distributed on paper. Frequently, the goal is to provide this same information in a more efficient and cost-effective manner. Examples of content on the Internet include practice marketing material, practice policies and directions to the office. Examples of intranet applications are distribution of management reports, policies and procedures, physician schedules, human resource information and events.
This is a logical starting point because there is minimal impact to practice operations. The Internet/intranet supports practice operations, but does not require changes to operations. Once a practice moves to subsequent phases and begins to exchange data electronically, the practice is required to revise operations to assure that information and requests are processed.
Phase II: Interactive Content
The second phase encompasses functionality that offers patients, physicians and staff the ability to exchange information online. The types of information exchanged support business functions but are not integrated into business applications. For example, a physician can request that a change be made to their schedule, but cannot make the change to the system. In this phase, medical practices are beginning to utilize the intranet to enhance businesses processes by improving the way information flows in the practice. The limit to this functionality is that business applications are not being accessed or changed over the Internet/intranet.
Practices can provide patients with the ability to complete a basic/generic health risk assessment online and submit it to the practice. Or, patients may be provided with the ability to submit demographic (insurance and address) changes to the practice over the Internet. This information is captured and stored by the practice, but may not be used to automatically update business applications. This will often require human intervention.
In addition, physicians begin to utilize e-mail that is incorporated in to the intranet to communicate with patients and other providers. Physicians are able to establish a dialogue with their patients and other physicians that is more effective than phone calls received during patient hours and messages returned between patients.
To be successful with interactive content, practices need to assure that the information submitted is processed. If a patient submits demographic changes online, the practice needs to establish policies and procedures to guarantee that business applications are updated. If handled effectively, this will begin to have a positive impact on practice operations.
Phase III: Semi-Integrated Processing
In Phase III, physicians and staff are able to query information from business applications and process selected functions. The focus of these applications is often to offer clinical decision support. The differentiation in this phase is that a request or query returns information that is specific to that request. For example, a primary care physician can use an intranet-enabled application to verify that a patient is still capitated to their office.
Physicians and staff will employ the intranet to support business processes. The information is provided through a variety of sources including internal databases, links to third parties and online references. Information on drug formularies or preferred/participating physician lists can be provided from an internal database or may require links to insurance companies. Drug-to-drug interaction information can be accessed from a physician online reference. The intranet can be the single source to identify the most appropriate source of information. This technology requires a searching mechanism and a back-end database or repository of information for each search. Functions that are often intranet-enabled during this phase include benefits inquiry, eligibility verification and specialist referrals.
Practices can utilize the Internet for personalized health risk assessments. Patients will gain access to the information by providing a user name and password. An application will provide forms or information specific to a medical condition that they have, as identified by the user name.
The Internet/intranet has become incorporated into how a practice operates. This requires changes to practice operations, but offers opportunities to redesign practice operations and achieve operating efficiencies. The Internet/intranet can be used to exchange data seamlessly.
Phase IV: Integrated Processing
In the final phase, physicians, staff and patients access, exchange and store information from applications and third parties. Messaging systems allow physician practices to make systems inter-operable and to automate and seamlessly exchange data over the Internet/intranet. Physicians, payors, clinical labs and pharmacies are linked for integrated processing. Physicians can process claims and referrals, receive lab results and submit electronic prescriptions. These functions are completed by business applications utilized by the practice and connected with partners over the Internet/intranet. Often this involves Web-enabling existing applications.
This provides physicians and staff with the ability to receive, store and manipulate data and automate office workflow. Physicians will be able to access a patient’s information and make changes to the data online. This is integrated processing because it is real-time, with no additional intervention.
Management information systems and electronic medical record vendors have begun to offer intranet-enabled versions of their products. The adoption of these applications will be slow due to the concerns of patient confidentiality. These concerns will delay widespread adoption of intranet-enabled electronic medical record systems.
The Internet/intranet is no longer incorporated into existing process, but will require a change in systems and how the practice operates. Back-end systems will require reengineering to develop necessary interfaces. Programmers will need to develop custom interfaces between the existing systems and the new electronic systems.
Security and Confidentiality
When a practice begins to exchange data that is specific to an individual, the need for appropriate security protection is dramatically increased. Patient confidentiality becomes a greater concern and more prominent requirement as a practice moves from Phase I to Phase IV. Legislation such as the Health Insurance Portability and Accountability Act and information security standards from organizations like the Joint Commission for Accreditation of Health Care Organizations (JCAHO) will require action and drive management to install and monitor security policies, procedures and systems to reduce the risk of liability.
As providers continue to face increased pressure to provide cost-effective, high-quality care and changing reimbursement methodologies, there is increased pressure to become more efficient and contain overhead. Improving the ability to seamlessly access and exchange information is crucial for achieving the necessary breakthroughs in both cost and quality of care.
The Internet/intranet can have a dramatic, positive impact on practice operations. Utilizing a phased approach will assist in slowly integrating it into your practice as you gain experience and success with the technology. Similar to other changes and investments, physicians need to understand the operational value and impact, and financial commitment and return on investment of taking their practice online.
Michael Cohen is a project leader at Actium@modis, a provider of information technology consulting, education services and products.