IDENTIFICATION OF THE SIGNIFICANCE OF THE PROBLEM OR OPPORTUNITY

Phase I Prototype Development in the Context of Rapidly Changing Health Care Management

Under Phase I funding CKSI has developed a prototype of protocol software designed to:

support flexible user definition of protocol triggers, actions, milestones, and allowable variance;
to monitor health care data in a wide range of hardware and software environments;
to alert appropriate providers, managers, or staff members when there are specific guidelines that need to be followed;
and to facilitate outcome and variance review.

We use the term "protocol engine" because our concept is of an intelligent application which will provide users with a great deal of flexibility and specificity in defining protocols. The Engine also works as a background monitoring agent within the user's current computerized environment, independent of user hardware type and data format. This product will be designed to work effectively either:

as an add-on to other applications.
as a separate but concurrent background process that will take control of the screen to issue warnings.
as an application that works independently to review health care data and ensures that appropriate standards of care have been met.

Most importantly this product must allow an organization to setup a uniform set of standards, and have quality of care and variances monitored, enforced, and analyzed with data from different sites and software packages. During the course of the Phase I grant, two major shifts occurred which altered the approach of this project. The first shift was a surprising and sudden growth in the popularity of the Internet. This shift was driven by the acceptance and possibilities presented by the popularity of the World Wide Web. The Web Browser has become the focal point of the desktop due to its power to integrate voice, e-mail, sound, images, and data into a single window in a platform independent application, and has greatly changed the way in which information could be handled. As a result of this trend we too modified our approach to take advantage of the location and platform independence demonstrated by the Web server and browser environment, with the opportunities to develop applications that allow data to easily be shared and accessed throughout organizations and communities. The second shift is in the rate of restructuring in the health care industry as it prepares to respond to steadily increasing pressure to cut costs. The health care industry is in a state of flux, alignments between clinics, hospitals, insurers, and employers are rapidly being formed, altered, and dissolved. In the year and a half since our phase I proposal was submitted less flexible and more traditional patient care software systems have struggled to make significant improvements in their ability to allow users to define, review, and monitor care guidelines. However, due to their platform and location specific nature, these systems tend to be extremely expensive, inflexible, and often require two or more groups to agree on a common standard. This is a significant problem. With the rapid realignment of the industry all physicians in one physical location may be members of different HMO's or provider groups. Our approach is designed to maximize and stimulate acceptance critical to success. It is a cost effective solution which is location and hardware independent and binds different health care systems into a virtual and continuous body capable of sharing transparently all health care related data. This is an absolute requisite needed to improve care quality and lower expense. 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. 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.