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Performance of Second 50 Completed ATP Projects — Status Report Number 3 NIST Special Publication 950-3 (January 2006)
Healthcare Industry Faces Challenges The U.S. healthcare industry faces the challenge to provide higher quality, lower cost service to an increasing number of customers. Information technology is seen as a valuable tool in reaching this goal. The medical field, however, is large, complex, and growing rapidly. Moreover, it is difficult to reduce operating costs and improve productivity levels because of factors such as institutional culture, interoperability issues, and business processes. Nevertheless, healthcare reform drives the need for interoperability within the industry, and healthcare institutions are recognizing the need to improve the exchange of data among their various operating entities and the wider healthcare community. During the mid-1990s, information management within the industry was not integrated, and patient information was often not readily accessible at the point of care. Healthcare professionals spent a great deal of time looking for records or repeating tests simply because they could not find previous test results in a timely manner. Infrastructure throughout the industry was fragmented, with individual institutions using unique diagnostic systems, internal data formats, patient record systems, and communication and computer networks. The healthcare industry needed systems that would ensure reliability, maintainability, and data integrity, as well as a high level of confidence that patient data would be available for every authorized healthcare professional 24 hours a day, 7 days a week. The lack of a complete infrastructure, combined with the technical risk inherent in developing systems to complete these tasks, prevented many commercial entities from attempting to make advancements in this area.
During the mid-1990s, information management within the industry was not integrated, and patient information was often not readily accessible at the point of care. The reengineering of medical information technology systems promised significant economic benefits and cost savings for healthcare organizations and patients. According to a 1992 study conducted by the Department of Health and Human Services, a nationwide electronic healthcare information network had the potential to save $100 billion over eight years, with more than half of the savings attributed to a reduction in both the number of diagnostic tests ordered and the length of hospital stays. The Clinical Data Repository Promises Infrastructure Integration In 1995, when 3M submitted its proposal to ATP, many disparate systems were used to store and transmit patient records data and other information within the healthcare industry. Various healthcare system vendors were beginning to develop central data repositories (CDRs) (later renamed clinical data repositories), but most of these CDRs offered limited capabilities with varying degrees of reliability, usability, and accessibility. Moreover, the healthcare industry faced the challenge of integrating information systems and automating data exchange processes across organizational components.The objective was to maintain computer-based Development of a CDR required a computer-based patient record. This record is the electronic format that holds data with standard components, such as the patient's demographic information, active problems, family history, test results, clinical observations, active medications, allergies, and any images and documents that accompany apatient's record. The objective was to maintain computer-based patient records in CDRs, which would contain the patient's lifetime records. 3M Health Information Systems conceptualized a system that would allow healthcare providers to maintain their investments in their legacy systems and migrate demographic and clinical information into a CDR. 3M Proposes to Accomplish Four Tasks 3M applied for funds under ATP's Information Infrastructure for Healthcare program to develop an infrastructure that would capture patient data, integrate it into a knowledge base, and make it accessible to the appropriate parties. The company believed that there was a good fit between ATP's objectives outlined in this program and 3M's development goals. Therefore, 3M submitted a proposal to ATP that included developing and testing the following components:
Collectively, these components would achieve something that had not yet been accomplished in the healthcare industry: access to data by multiple individuals at various locations, regardless of the type of system each was using. This effort would rely on a terminology program that would be created to provide a universal dictionary for common medical terminology. 3M Achieves Technical Success During this two-year ATP project, 3M completed the four tasks summarized above. The company achieved its project goals by developing a prototype and conducting beta testing at a number of hospitals. Based on the feedback that 3M gained through prototyping, the company developed "plug-and-play" interoperability between applications, or components of applications between the database objects, and the healthcare data dictionary. CDR Becomes Part of 3M's Care Innovation System Since completion of the project in 1997, 3M has leveraged the technology to further develop its healthcare information system products. The company has incorporated the components developed through this ATP-funded project into other development activities within 3M. It markets the technology as part of its Care Innovation (CI) System (formerly called the Healthcare Enterprise Management System), along with the company's established applications such as the 3M Clinical Workstation. Through further development, 3M has commercialized new software packages that use this technology. According to the company, the software will become the foundation for the Department of Defense Military Health System's computer-based patient record program, which is aimed at improving healthcare delivery to military personnel. The CI System is currently being used in more than 150 healthcare facilities. Additional marketing efforts are under way to encourage other vendors to embed pieces of the CDR functionality into their systems. CDR Benefits Extend to End Users The end users of 3M's CDR have benefited from its use without having to make a substantial investment in new systems. Many healthcare providers were able to protect their investments in legacy systems and migrate demographic and clinical information by linking together previously installed systems rather than having to install new ones. Two institutions that have realized benefits from the CDR are Health Partners of Southern Arizona (HPSA) and Driscoll Children's Hospital. HPSA successfully used CDR to unite all of its care facilities using a single source for information. HPSA needed one central patient index with common identifiers and a way to ensure accuracy, integrity, and encoding of the data. The central patient identifiers and translation of data into common nomenclature offered by the CDR enabled HPSA to reach this goal and achieve economies of scale. Driscoll Children's Hospital, a regional pediatric referral medical center with offices throughout rural areas in southern Texas, used the CDR technology to solve the challenges of sharing data among geographically dispersed locations while preserving its original investment in its legacy systems. CDR seamlessly integrated data from Driscoll Children's Hospital and clinics into individual, longitudinal patient records. The system helps to provide Driscoll clinicians with expert decision support tools at the point of care, which can make a difference in both outcomes and cost. Conclusion The ability to demonstrate the components of this ATP project through prototypes and beta tests helped the Health Information Systems division of 3M garner support from within 3M to internally fund additional developments. Furthermore, based on the support it received from ATP, 3M was able to introduce this technology into the healthcare marketplace two years ahead of schedule. According to 3M, "The work that was accomplished with the help of ATP in the Information Infrastructure for Healthcare focused program, along with access to NIST technologists with standards experience, gives us the capability to respond to market needs."
Research and data for Status Report 94-04-0027 were collected during October - December 2001. Return to Table of Contents or go to next section of Status Report No. 3. Date created: April 4, 2006 |
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ATP website comments: webmaster-atp@nist.gov / Technical ATP inquiries: InfoCoord.ATP@nist.gov. NIST is an agency of the U.S. Commerce Department |
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