Web-Enabled Integration of Patient Data and Clinical Guidelines for Coordinated Care

Abstract

A variety of forces are encouraging change in the healthcare systems of developed countries. Chief among these is perception of high (and rising) cost. The arsenal of tests, medications and procedures at the hands of Western medicine is ever-increasing. This, in concert with an aging population, has brought the health expenditures in the U.S., EU, Japan and Australia edging to just under 10% of GNP. Furthermore, there is concern about waste of resources, principally through lack of coordination between healthcare facilities resulting in redundant investigations. A more subtle force comes from the rise of evidence-based medicine (EBM), as illustrated, for instance, by the extensive consolidated clinical reviews of the Cochrane Collaboration. EBM highlights that typical medical practice is not necessarily efficient or effective in all cases as compared to well-established findings of randomized controlled trials (e.g., Sydney GPs have been observed to over-prescribe antibiotics, which is both a waste and a community health hazard [Bolton et al., 1996]). Happily, as motivations for change rise, we see the emergence of technologies with great promise for implementing solutions. The most obvious of these is of course Web technology. Cimino et al. (1995) illustrated (at a time that can now be considered early in the brief history of the Web) that intranet-based Web technology could provide a breakthrough in ease of integration of legacy information systems within a hospital environment, and thus be the basis for innovative clinical workstations within the hospital walls. More recently Cimino et al. (1998) have illustrated technical solutions to control the security and confidentiality risks associated with external access to the hospital intranet data. Moreover, as one uses an intranet for integration of patient data, they can simultaneously access internal (intranet) and/or external (Internet) decision support resources (such as access to Medline illustrated by Cimino et al., 1995).