High-tech healthcare: Page 2

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CareWeb doesn't overlook insurance providers, either. For example, one application gives insurance providers in Massachusetts access to CareWeb so that insurance transactions can be conducted over the Web. CareGroup has interfaced to Harvard Pilgrim Health Care, Medicaid, Medicare, and Tufts Health Plan, and it is actively pursuing a relationship with Blue Cross and Blue Shield of Massachusetts. Currently, insurance providers can transmit information on benefits and eligibility, and CareGroup will have referral and authorization applications later this month. By the end of 2000, it will be possible to submit claims over CareWeb.

Because key patient data-such as eligibility, date of birth, address, and age-are all recorded in a single database that is shared between CareGroup and insurance providers, both parties have identical patient information. The intranet helps eliminate costly mistakes; information does not need to be reentered each time a claim is filed. According to Halamka, the cost in payment denials resulting from mismatched patient data has already been reduced from $8 million to $6 million.

What makes CareWeb tick

CareGroup includes six hospitals, 2,500 providers, and 800,000 patients in the Northeastern United States. The CareWeb system consolidates medical records from geographically dispersed patients into a single clinical database accessible via a browser. As many as 12,000 end users--including doctors, nurses, technicians, lab staff, patients, and insurance companies--currently access CareWeb.

What to do when planning an intranet information exchange

Deploy the intranet incrementally.


Go for quick wins, such as office supply ordering.


Constantly evaluate Web applications to stay current.


Be aware that the process and the change management are more important than the technology.


Remember that security and confidentiality are of paramount importance.

The intranet's infrastructure relies primarily on Microsoft Corp. technology: Windows NT is the platform for its fleet of 173 servers. Included in the mix are Microsoft Exchange 5.5 mail servers; Microsoft Internet Information Server (IIS) 4.0 Web servers; Microsoft SQL Server 7.0 servers for storing financial transactional data; and InterSystems Corp.'s CACHI e-DBMS software, the primary database repository for all of the clinical systems.

CareGroup chose the CACHI product for hosting clinical data because medical information lends itself to a hierarchical rather than relational database structure. "Patients have labs and they are not interrelated," says Halamka. "The patient is at the top of the tree, and all labs are leaves in the tree, so if you use a hierarchical database, it's really fast." As much as 90GB worth of clinical data is housed in the intranet database.

That amount of data is not surprising: There is a computer in every exam room, in hallways, "everywhere you turn, so that wherever you happen to take care of a patient, information is available to you. We can provide prescriptions more carefully [and] more legibly, and CareWeb helps providers keep track of the patient's problem list," says Sands. He describes treating one patient who complained of unusual symptoms. Rather than shuffling through paper charts, Sands looked up the patient's history and quickly diagnosed and solved the problem.

Physicians can also log on remotely; CareWeb uses RSA Security Inc.'s RSA SecureID technology, which maintains secure authorization through continually changing passwords. "Let's say I'm at home and I get a call from the lab saying that somebody's blood count was 17. In the old days, I would have been stuck with no access to patient information," says Dr. Richard Parker, another Boston-based CareGroup physician. "Now I am able to go into my computer at home, link into the system at work, pull up information, understand all of the patient's problems, and know exactly what to do."

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