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Capgemini

• Real-time access to more complete clinical information anywhere, anytime, on any device.
• Clinical workflow improvements through the use of various wireless devices.
• Complex, critical, and time-sensitive information sent automatically to clinicians based on their individual preferences, wherever they are, however they are connected.
• Learning systems that automatically adapt to constantly changing requirements.

Thanks to the emergence of new technologies and new technology standards, there is a new approach for sharing clinical information — the Web services framework (WSF). This approach is not pie-in-the-sky wishful thinking. Based on our work in the health care and other industries, we believe that this new model is the future of clinical information systems. And the future is now.

The Web Services Model: A Cure for Skepticism

Clinical information technology has never been better, and spending on new information systems has never been greater. Nevertheless, hospitals and clinicians are growing increasingly skeptical about what technology can actually deliver. In fact, many skeptics would say that technology routinely over-promises and under-delivers relative to the industry's real information needs.

The root cause of this skepticism isn't hard to find. Despite recent advances in technology, no one vendor solution is able to meet the complete information needs of hospitals and clinicians. That is to say, no one vendor has been able to deliver clinical information in a way that enhances efficiency and effectiveness while providing a level of security that goes beyond the regulations to give patients complete confidence that their information isn't being compromised.

We believe that the Web services framework, developed first in other industries, offers a solution to this problem. Based on open standards and interoperability, WSF enables all clinical information holders (hospitals, clinicians, and insurance companies) to make their information accessible to all authorized requesters (patients, caregivers, and hospitals) through simple, electronic queries.

Based on our work with the WSF in the health care industry, we are convinced that this emerging model has the power to make clinical information systems faster, more effective, and less expensive than before. It will have a dramatic and global impact on health care, transforming the accessing, delivery, and financing of care. WSF is a wave of a future that is already upon us and will, we believe, turn the skeptical and disheartened into enthusiastic users.

What WSF Can Do for You

WSF will transform health care by dramatically improving open, but secure access to useful and useable information by all health care stakeholders. Specifically, it will enhance information sharing among systems, workflow, security, and collaboration.

Information-Sharing Among Systems

WSF is not about retrofitting legacy systems with Web capabilities. Thanks to the WS3 Committee on Defining Web Services, WSF reaches down into a system's data, protocol, messaging, rules, and business layers to create complete interoperability between systems. With WSF, specialized systems (such as a laboratory information system) can perform highly specialized functions within a hospital and, at the same time, share information easily, but securely with other systems at their request. XML, WSDL, and UDDI are some of the tools that enable WSF-based systems to share information freely.

Workflow

Health care information is inherently dynamic. To do their jobs efficiently and effectively, health care professionals have a constant need for consolidated and timely information related to accessing, delivering, and financing care. WSF answers this constellation of information needs with "clinical portals" that provide a dynamic and interactive view of clinical information.

WSF-based clinical portals do much more than pull patient information and display it on a Web page. They actually reach down into the logic of different applications in order to bring up information that has been synchronized by the user's very request for it. For example, the "home page" of a physician's portal might show a personal and hospital schedule, a list of patients, and content sources. When the doctor selects a particular patient, the windows will change to display that patient's next scheduled appointment, recent lab results, and personal health record. To achieve this consolidated and highly specific view of dynamic patient information, the system must run several applications simultaneously and synchronize them in accord with the user's request.

Mobility

Another key ingredient in improved workflow is mobility. Within WSF, however, mobility is much more than putting a Web site or an application onto a PDA or Pocket PC. Under this new model, users can perform any task on their computing devices without having to think about whether they are connected, or how they are connected, to a server. "Occasionally connected computing," the term for this new form of mobility, means that a user's computing device and applications communicate with each other about the kind of connection required for the user's task (regardless of when it occurs) and settle competing priorities for communicating with the server most effectively in this particular case — all without the user ever having to think about what is happening behind the scenes. The benefit is clear: Users no longer have to worry about synching their various devices. They no longer need to know whether they are connected or if the connection will impinge on their ability to perform a particular task. Whether ordering lab tests or prescribing medicine, they can simply go about doing their work. Anywhere and under any circumstances.

Proactive Messaging

Improved workflow also means that users don't always have to request the information they need to see. Thanks to the enhanced computing power now sitting on their devices (a requirement for occasionally connected computing) critical and time-sensitive information can be "pushed" to users without their having to "pull" it up.

For example, if the system knows that a specific set of lab results is associated with a particular patient and physician, it can send those results to the physician automatically before he or she requests them. And that is just the start. The physician could predefine "next steps" (such as follow-up tests or appointments) that would be triggered when a specific set or range of lab results for a specific patient were received.

Based on individualized profiles and defined parameters, WSF-based systems can ensure that clinicians receive critical and time-sensitive clinical information timely, regardless of where they are or what device they use. The information can follow them around — from PC to PDA to mobile phone, wherever they go — from hospital to office to car to home, regardless of the type of connection they have with the information source. As their need for information changes, users can change their profiles and preferences to eliminate unimportant and wasteful information flow.

Greater Efficiency Through Learning

WSF enables you to add an additional layer of business logic that can learn users' needs based on previous interactions with other systems. By creating a learning system that constantly interacts with specialty systems, (lab systems or prescription ordering, for example) you can eliminate repetitive tasks, not through hard-coded rules, but through a dynamic system that constantly adjusts to changes in need. For example, if a certain insurance company always requires a referral with a specific diagnosis, the system will learn this from previous staff actions and automate the referral process. Another insurance company may require a different action with the same diagnosis, and that is precisely the point. You don't need to know — and hard-code — all the details in advance: the system will learn them and will change its response if and when they change automatically. Not only is the clinical and administrative staff relieved of performing repetitive tasks, your IT staff is relieved of having to constantly reprogram rules to adjust to a changing health care business environment.

Security

All hospitals must authenticate and authorize user access to their systems. Maintaining the back-room systems for these security functions is expensive and increases overhead. In Washington state, we are now seeing the emergence of a new WSF-based system that enables separate hospitals to authenticate and authorize through one service. New WSF and CCOW standards (the latter an HL7 subcommittee on authorizing access based on health care roles) have now made this new approach possible.

Other applications of this new WSF-based approach? Suppose registration needs to determine a patient's co-pay, eligibility, or referral options. Instead of staff having to call the insurance provider or query back-room systems, the hospital's system can now interact with the provider's system directly to get this information, bypassing even the need for back-room functions.

Collaboration

WSF will fundamentally change the way clinicians — indeed all health care stakeholders involved in accessing, delivering, or financing care — work together. Through technologies like secure instant messaging, a clinician can interact in real-time with a patient, other clinicians, or a caseworker at an insurance company. Suddenly, the entire process becomes much more collaborative than ever before. And the completeness and dynamism of the information shared and the mobility of the collaborating parties only enhance collaboration. WSF makes possible entirely faster, more efficient, and richer ways for all health care stakeholders to work and communicate.

Barriers to Change

This is the future we see happening in the next three to five years. But, of course, nothing about the future is certain. Barriers could arise to slow or thwart these developments. For example:

• Technology vendors who are unwilling to adopt open standards and expose their proprietary information to the outside.
• Health care providers that horde clinical information about patients to try to gain competitive advantage over competing institutions.
• Technology design that doesn't take into account the way people like to interact with technology and therefore isn't intuitively useable.

Any of these barriers could compromise the improvements in health care that WSF promises to deliver in the next three to five years. Fortunately, many of these potential barriers are within the industry's control.

Summary: The Future is Now

What is the future of clinical information systems?

• More complete and dynamic clinical information
• Real-time access to information and robust clinical functionality any time, anywhere, and from any device
• More efficient workflows and processes that adapt to a changing health care environment
• More cost-effective security processes

In short, open, untethered information and workflow, responsive only to the needs of patients, clinicians, and health care organizations.

This is the health care future made possible by WSF. Much of it is available right now.