All of the technologies used on the Internet can be applied and implemented on private, low cost medical intranets. A local medical intranet could be composed of doctors, medical staff, laboratories, medical managers, and payors. It would work from off-site over a simple phone line and have the look, feel, and function of on-site network access. To isolated clinics or remote doctors, as well as to the payors and health care managers who need to keep in close contact with them, the benefit of data sharing with integrated functionality is very attractive from all perspectives.

Given the current need for a virtual network in which managed care and HMO's can form and prosper, the necessity for consolidating and sharing data from a variety of diverse sources and locations is squarely upon us. TCP/IP solutions i.e.: Web browsers and servers provide a low cost solution to a coalescing medical community. A solution with platform and location independence best serves to address the immediate need to share information between hospitals, insurers, management organizations, laboratories, clinics, and physicians, wherever they be physically located. All health care organizations need ways to work with and add value to the legacy systems while making a smooth transition to more modern and robust data sharing solutions. Again, this is the focus, the underlying premise of the method we employ and wish to develop further with Phase II funds.

By developing standard of care and quality monitoring software for an Internet environment we gain the following efficiencies:

1. To be really useful a rules monitoring software should have access to computerized lab data, to chart notes and treatment plans. In an Internet environment there are many more options for setting up this sort of accessibility without incurring inordinate costs.
2. Data from all of an organization's locations can be accessed from any site. Critical data can be compiled and centralized.
3. Managers will have immediate access to latest information.
4. Updates to products and rules can be made easily, and will take effect immediately. It will not be necessary to ship out disks containing changes to all locations.

Integration with systems already developed to maintain on-line lab results and chart notes for an organization will make it possible to take full advantage of the network to improve efficiency. For example a physician may see that he needs a variance from a particular set of guidelines. By clicking on the reason for the variance and adding his own comments, he will automatically generate an e-mail notification to a case manager at another office, who will later be able to examine his notes, review the patient's chart notes, and then either approve the variance or follow up with the physician. Physicians will also have capability to quickly pull up a review of all previous instances in which a particular protocol was triggered, to see how many times rules were followed, and how many times variances were requested or authorized to see how closely circumstances in those cases match his current situation.

By using a Web Server with Java and Netscape, we will be constructing a system that is completely portable. It will run on Internet or intranet connections between clinic and insurance companies or managed care associations, regardless or their distance apart. Data links can be customized at each clinic. Data links are very helpful, and greatly improve efficiency but they are not mandatory. The system can be used with or without data links.

We have potential not only for real time monitoring of protocols, but the possibility of management being notified immediately when there are variances. This adds a great element of flexibility to what would otherwise seem a strict protocol system. By management receiving immediate notification, variances can be requested, and quickly authorized or further discussed. It can be part of planning process rather than an after the fact questioning or review.