As the health care industry realigns and repositions itself and works to improve its cost effectiveness and efficiency, the ability to transfer and integrate data from different systems, software, and sites is becoming essential. More and more, software vendors are converting to "open architecture" data storage, where data is stored in formats that can be accessed by other parties, independent of the original software system or are providing secondary output of their data in documented and standardized formats such as HL-7.

Open architecture data storage and the rapidly improving technologies being developed for web/Internet environments now make it possible to successfully produce an application designed as an add-on to be used in concert with different software systems running at different locations. Thus, on a single desk-top with an open architecture database, it will be possible to run a data entry and billing system with the data and program stored and residing locally and a protocol system set up on a web server in a completely different geographic location which will be monitoring data entered on the local system, and initiating data transmissions and requests.

For the past twelve years, CK Software, Inc. (CKSI, aka CK Computer Consultants) has designed, developed, evaluated and supported DOS-based health care management software for physician offices, clinics, occupational health services, various other hospital departments and utilization review services. In all of these different settings, we have had first hand experience working closely with users to design and then support health care applications. We also have given a great deal of thought to the specifics of protocol implementation and understand how explicitly rules need to be defined if they are to work properly on a computer. In developing our prototype protocol engine with Phase I SBIR funding from HCFA we have conducted a detailed review of the different design elements needed to efficiently monitor and enforce rules that users can design themselves. In our prototype we have illustrated the way in which rules' monitoring and enforcement can work efficiently in an environment with different data sources and locations. We have demonstrated how to separate protocol definitions from data definitions, so a protocol can be monitored and enforced on a variety of different types of systems running different kinds of software.

In the process of discussing the prototype with other vendors, CKSI encountered Med-Recall, an emerging company specializing in the development of Internet environment health care data compilation methods. MedRecall is prototyping a system in which lab results, physicians' comments, patient allergies, on-line prescription submittals, patients' facial portraits and signature, voice conferencing, and chart notes from providers in multiple locations are captured from different sources and compiled for display via a Web Server. Any provider or insurance representative with appropriate security clearance can connect from any location and view all chart notes, test results, etc. for a patient as well as doing key word searches and queries. The opportunity for and benefits of cooperation between our two groups were immediately apparent. With the continued help of Med Recall, CKSI will be able deploy the protocol engine in an intranet environment and have access to tested methods for assembling and compiling data from software and data sets on Data General mainframes, RS6000 and AS400 systems, Novell servers and Oracle and Sybase databases. Our ck_Medical billing package can provide Med Recall a source of "live data" producing real time transaction output. Together, our combined skills will enable us to integrate data from different hardware and software platforms with a dynamic data feedback and analysis mechanism accessible to all users as a natural extension of current Internet based application paradigms.

The challenge in medicine is cost reduction. To meet this challenge grants such as this one have been let with the hope of accelerating a marriage of creative solutions and new technologies. The ultimate goal is to extract relevant information from wherever it is gathered and use it to help make better medical decisions. Due to the diversity of clinic, hospitals, data types, and connectivity options to be viable any solution must be open and flexible. It will be a solution that is platform independent, has a minimal support need, will work on older computer hardware and can bring physically separated organizations together electronically. We have such a solution under development. It uses the language of the Internet, TCP/IP; it works from home over a simple phone line exactly as it does over a Ethernet hospital LAN and can encapsulate the isolated clinic or remote doctor into a wide area data sharing network for the cost of an extra phone line and modem.

Our solution allows a virtual network of data users and providers to function as one contiguous entity. Our methods insure the fastest access to information and a way to insure that the correct protocols reach the user. Our methods allow tightly controlled access to the data as well as a means with which to gather, process, and display information in a timely fashion using existing hardware with the barest of personnel training or support.

Our method maximizes cost effectiveness by using well known and familiar software like the Netscape Browser, and Netscape's integrated POP3 e-mail client. Connection costs are reduced to the cost of standard telephone lines and all information is distributed from a web server with a look and function users will already be familiar with, dramatically cutting re-training costs.

Another key factor often over looked in solution design is user engagement. Our methods engage the user, demand their attention, and with this comes an increased willingness to input data and use the system regularly and as designed.

Our solution is a straight forward presentation backed by a powerful protocol engine and data collection strategy. Together proactive warnings, trends, and irregular tendency can be spotted, corrected, and monitored. An insurer in Virginia could be "notified" via e-mail by the efforts of our protocol engine if a trigger was defined. A cardiologist could see real time patient data in a small window on her office PC and automatically be paged, via e-mail, if vital signs drifted out of a normal range.

Our protocol engine dynamically analyzes data and reports back to involved or affected parties using methods that closely models today's Internet environment. With Phase II monies we will define protocol mechanisms explicitly targeted to the needs of those people who directly contribute and control medical expenses. Our system can be setup to work with data gathered from diverse environments. It then can be offered to both ends of the software market -- to software vendors as an add-on to their products or to software users as "middleware" that can run concurrently with their primary data entry system.

While there are technical challenges to overcome in order to develop a such a system, the rewards will be enormous. Once systems are configured properly to meet the needs of the practice and all necessary data entered, computers can monitor enormous amounts of information very efficiently and immediately draw attention to any care plans that fail to meet standards. Such a system also can provide the valuable analytical and historical information necessary to make decisions which improve service delivery and health care outcomes.