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Lotus Notes is the physician's Rx: A healthy dose of Domino is the cure for healthcare provider

This article appears in the issue February 1998 [Volume 7, Issue 2]

Hospitals continually face two challenges. The first is to provide the best patient care possible. The other challenge is to attract physician partnerships to the hospital's network of providers. If a hospital cannot draw and keep those partnerships within their physician networks, they stand to lose the physicians' patients to a competing hospital. Lost patients mean revenue they won't have available to improve patient care.

Providing timely patient information and the tools to access it is one of the weapons hospitals can use to fight off the competition. Providing the right information at the right time is even more critical when it comes to patient care.

Supplying superior service to the physician partnerships will also translate into improved patient care. So everyone wins--the hospital, the physicians and the patients.

The task

How can a hospital maintain a high standard of patient care and provide easy access to patient information so doctors can make knowledgeable decisions? That was the task that faced Crouse Hospital (Syracuse, NY), but there were other questions, too, that needed answers:

* How do you support up to 800 user physicians with a new state-of-the-art information system without overextending the support staff?

* How do you train busy doctors who do not have the time to learn sophisticated software applications?

* How do you transfer vital patient data from six disparate information systems into one easy-to-use system for non-technical users?

* How do you maintain the confidentiality of sensitive patient information and still provide high accessibility to the right people?

Those are just some of the questions that were presented to Health Care Data Systems (HCDS), the information systems subsidiary of Crouse Hospital.

In the past, HCDS' primary means of offering physicians access to patient information was via 3270 emulation to its mainframe using a non-intuitive, character-based interface.

Setting up access to the mainframe system could be a challenge since the 3270 emulation software had to be installed and configured on each physician's PC. Since HCDS did not own the physician's PC or have control over the type of PC used, setting up a new physician could be a time-consuming task. Configurations could be changed by the user accidentally (or by their kids since some physicians wanted access from their home PCs). Those were the problems placed on the shoulders of HCDS' support staff. With the desire to grow the physician base, adding more users could mean more support issues for the staff.

HCDS started looking into a solution two years ago. At that time, most physician access systems were client-server based and thus required more support than HCDS had in mind.

Requirements for the new system had to include being intuitive using a graphical interface and incorporating a Web browser for the front-end software. By using a browser and an intranet approach, HCDS could avoid the long design and implementation process that is normally associated with many client-server applications.

With the help of integrator Ikon Office Solutions (Buffalo, NY), Chuck Fennell, VP of Health Systems at Health Care Data Systems, tackled the challenge using Lotus Notes Domino solution from Lotus Development (Cambridge, MA). Now physicians just need a modem and a browser to use the new physician access system called EntryNet.

With Notes acting as a meta server, pulling data from several different applications and server platforms, physicians have one easy-to-view access point for the up-to-date patient information. Using Lotus' Domino Web server and a Notes application written by Ikon, EntryNet pulls information from laboratory reports on an RS/6000, radiology reports from a DEC Alpha, transcription reports operating on a Windows NT platform and census and patient information running on the mainframe.

Taking the unstructured data from various systems and presenting it to physicians from a single log-on screen proved to be the ideal solution. Now HCDS' Domino-based intranet can provide support to all 800 physicians with only an inexpensive or free browser on their PCs.

Adding additional users is as easy as giving them an ID and password. No more visits to the physicians' offices to load (or reload) 3270 emulation software. Since most physicians already have a home PC with a Web browser installed, training is less than with a client-server application.

HCDS has one Intel-based server acting as the import manager, pulling data twice an hour from the many systems and importing it into the Domino Web server. Domino offers a more scalable solution than other physician access systems.

HCDS can move to either faster or multiple processors without having to rewrite the application. EntryNet also allows HCDS to adopt new features from Lotus as they become available. The hospital would like to expand the system to streamline communications with the insurance companies to further reduce administrative burdens.

Other considerations

Another major consideration for a new system was providing a secure platform to house sensitive patient information. Lotus Domino's security conforms with HL7 (Health Level 7) standards for integrating patient information.

Besides the physician access systems project, HCDS was looking into a new messaging system for its organization. Notes' strong E-mail platform fit HCDS' requirements.

Based on early feedback for EntryNet, capturing all the information from those disparate systems and allowing the physicians to turn it into knowledge for better patient care has proven to be a success. HCDS is so confident of EntryNet that it will market it to other hospitals around the country.

So instead of installing, configuring and supporting up to 800 client PCs, HCDS only has to worry about supporting one Web server and the data import server. Sounds like the doctors were prescribed the right dose of medicine. *

Steve Goodfellow is president of Access Systems (Manlius, NY), an independent consultant on knowledge management and marketing strategies, 315-682-1188, fax 315-682-0865, E-mail Sgoodfello@AOL.com


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