Guest Columnist
Technology Cornerstones to Support Tomorrow’s Healthcare System
Mar 1, 2010 - 5:08:22 PM

( - New technologies ranging from sensors and smart phones to converged networks and cloud computing have dramatically improved the infrastructure capabilities of healthcare IT. Health information and knowledge now stretch far beyond traditional geographic and care delivery boundaries, enabling care to be delivered to patients wherever they are located and whenever they need it.

With all of the different technologies that are now available, care communities, patients, care givers and consumers need to develop a vision of how care delivery practices and processes should fit together, which data are shared and how, and which are the most suitable applications and technologies.

For example, post-operative patients can be monitored remotely, nurses can have instant access to patient records and preferences, and physicians can respond to lab notifications instantly using their smartphones. These types of advancements make care safer, more effective, and more efficient.

The infrastructure needed to achieve this level of care in a manner that is fully customized to the individual’s role, information needs, access preferences, and location is the technological base (cornerstones) for supporting tomorrow’s healthcare system.

Table 1: Infrastructure Technology Cornerstones

For a summary of Technology Cornerstone, click here: Technology Cornerstones

Cornerstone #1: Empowering the Mobile End-User

There is still no single end-user device that can satisfy the needs of all end-users. In the healthcare system of tomorrow, the best device for a given person will be determined by his or her needs and role within the organization.

For example, multi-functional smartphones with integrated medical attachments provide accessibility for mobile caregivers within the hospital and for patients at home. This may be an excellent option for nurses who receive notifications about patient arrivals and scan patient wristbands with the same device. Wireless tablets and laptops, however, may make more sense for caregivers performing medication administration and clinical documentation.

In tomorrow’s healthcare, nurses and physicians can receive messages on the device of their choice, based on the time of day, the type of message, and other factors such as whether they are on call.

Lab results can be sent to a physician as an email, text message, or voice recording, based on his or her preferences. Caregivers are no longer limited to the telephone to communicate with colleagues. This capability is called unified messaging communications and intelligent interactions, and can be achieved by integrating the hospital’s clinical system, identity management system, and coverage schedule together with the devices carried by the end-users. With this solution in place, care providers can respond immediately as the messages are intelligently routed, which saves time and speeds patient care.

Cornerstone #2: Accessing Information From Any Place

Physical location is no longer a barrier for users who need to send and receive information. In tomorrow’s healthcare system, organizations combine wired and wireless technologies seamlessly. As end-users move from the hospital to the provider office to home, they can connect to the applications and data that they need in a secure and authenticated way.

Converged wireless networking allows facilities to install one network and then plug in additional modules as new wireless technologies are needed. The system relies on a distributed antenna system (DAS) that can handle cellular service, sensors, medical telemetry, web traffic, security alarms, and real-time location devices. Converged wireless networking enhances cellular reception within hospitals, eliminating dead zones and connecting communication systems together. For example, users can set their communications preferences and receive email, voicemail, faxes, and even calendar events in a single inbox.

Dual-mode phones and global positioning system (GPS) technologies extend mobile capabilities even further. Tracking can be integrated into smartphones, portable medical equipment, and even wristwatches to provide smarter and quicker responses. Short-range solutions are also important. Body Area Networks (BANs) collect and transmit patient vital signs, body functions, and physical movement, while Personal Area Networks (PANs) enable users to send and receive information between personal medical devices such as glucose meters and smartphones. These are a critical part of the growing trend of collecting data throughout the day to identify trends and directly involve patients in their care.

Cornerstone #3: Accessing All the Information Users Need

Tomorrow’s healthcare system will make use of information that comes from a greater variety of sources. For instance, data will come from patient self-care medical and communication devices, personal health records (PHRs), specialists’ systems, health insurance claims, pharmacies, pharmacy benefit management companies, and other sources.

For healthcare organizations, this is another data stream to monitor and act upon. At minimum, tomorrow’s organizations will need to:

* Integrate with remote monitors and devices
* Integrate with the electronic health record (EHR) and PHR
* Provide real-time feedback to patients about their health, progress, and goals
* Send alerts and reminders when measurements are missing or out-of-range
* Integrate with other caregivers, family members or call centers

A related concept is Health 2.0, which refers to patients collaborating with caregivers and each other interactively over the web. For instance, patients can attend online group meetings led by care mentors, or trade information about which treatments and exercise regimens work best.

Organizations can also make productive secondary use of these data. Health intelligence tools can generate valuable patient population statistics and reveal important trends. Users can perform analytics, predictive modeling, and generate customized dashboards to monitor operations. This results in improved efficiency and proactive management.

Cornerstone #4: Delivering Processing Power on Demand

Tomorrow’s healthcare IT solutions need to be available at all times because users expect to be able to access data and applications whenever needed. Systems should be both scalable and reliable. They need to be protected from potential disaster and recoverable within seconds in the event of catastrophic failure, regardless of whether they are located in-house or beyond the organization’s physical boundaries.

For data storage, this means that systems need to include redundant components, proactive “phone home” support, and data mirroring to ensure continuous availability of data during planned and unplanned outages. Databases and computing platforms need to be built upon high-availability architectures that support redundancy. Likewise, networks need to be highly resilient. To ensure that information is always available, organizations should consider multi-function routers with hot standby protocols, switches with security filters, integrated server load balancing, and private local-area networking.

Server virtualization is one technology that helps to deliver processing power on demand. Virtualization enables multiple servers to run on a single machine, allowing resources to be allocated more efficiently. Virtual machines can also reduce costs, simplify maintenance, and increase resource utilization.

Another key technology in this cornerstone is cloud computing. Cloud computing is a type of system architecture that creates a shared pool of servers, storage, and other resources that can be rapidly provisioned as needed. It enables organizations to manage the utilization peaks and valleys typically associated with resource-intensive applications with maximum agility.

The cloud model can be used to handle business certain processes (e.g. accounts receivable or payroll), software programs (e.g. project management tools), or infrastructure requirements (e.g. hardware and storage). Organizations often start with back-office functions such as email before moving to more advanced operational areas. Although cloud computing is in widespread use in some industries, few healthcare organizations have used it yet to support areas such as patient care or public health reporting.

Making the Cornerstones Secure

For each of the cornerstones, it is important to achieve the appropriate level of security. Security takes the form of toolsets and knowledge bases that store and manage end-user access rights. Capabilities include:

* Tools that prevent entry (firewalls, Virtual Private Networks),
* Tools that authorize access (ID badges, biometrics, passwords), and
* Tools that monitor events to detect entry and access by unauthorized users (intrusion detection systems).

These tools, in conjunction with an Identity Management system to manage access rights and privileges, can ensure that end-users are only able to access what is appropriate given their role in the organization. Furthermore, security is not limited to within the confines of a provider organization. Since healthcare data access, data capture, and analysis can occur anyplace, identity management needs to include business partners, suppliers, patients, and customers.

Bottom Line

As long as the technology cornerstones are balanced and secure, organizations will be able to implement in an efficient and effective way new applications that meet the growing demands of all authorized end-users.

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