John
>Very interesting. Can you enlarge on 'fully transactional (read +
>write) systems'? Are there any accessible sites running this kind of
>system and what SW would one need to access them? I find it difficult
>to picture what exactly would be exchanged in this way and how it would
>be treated by the receiving system.
Basically the Web used in the way I am suggesting allows you to drop
the mental and/or physical association that we have all made over the
years between information and computer systems. What I mean by that
is that, if you think about it, the only reason we think in terms of
exchanging information (eg between hospital and GP say), is because we
always assume that you (the GP) can only view, print, analyse,
manipulate or whatever some relevant information the hospital
obtained about a patient by actually acquiring a copy of that
information yourself and having it incorporated in your computer
system's database structure for subsequent use.
With the Web approach, all those forms of access to the patient's
information that you require could, in theory at least, be achieved
via a Web browser on your desktop, via network connections to the
hospital(s) etc that have the various bits of relevant information
about the patient (direct connection, NWN, Internet via tunnelling
protocol etc), and via a Web-enabled linkage to the hospitals' (and
other) systems. Your browser and the network provide the integration
mechanism. And think of your GP system as just one source of the
patient's total record, and just one place your browser could be
pointed at to retrieve the total information. A distributed patient
record ?
Now this is radical stuff ! So let's take it one step at a time.
At its simplest, then, with only a Web browser and a suitable network
connection, you could gain access to other NHS organisation's systems,
via HTML forms and other dynamic web pages generated by their system
to allow you limited access (under their control) to the information
they hold. Your Web browser is, if you like, a dumb terminal (albeit
a bloody clever one!) giving access to their system - you're just
another user of their system (full transactional read/write access,
albeit with special, limited access rights). Navigation through their
system is presented to you as a series of forms and hyperlink menus.
Presentation of the information you want is in the form of HTML pages
marked up "on the fly" according to the actual content of the
patient's information. That information could include not only
textual information but also images and sound files associated with
the patient (X Rays, radiologist's dictated reports, etc). That would
be then down to local GPs and the hospital to determine what
information and in what media is it beneficial for you to have access
to it.
Taken to its further limits however, your Web browser can provide the
means to pull together the relevant bits of the patient record onto
your screen. Developments such as frames, Active X components and
Java objects etc mean the relevance of the "system" - ie the physical
location of the information - becomes blurred if not irrelevant.
Clearly this is dependant on a number of things happening and being
available, so we're not there yet, but it's not difficult (and IMHO is
inevitable because this is exactly where Netscape, Microsoft, Oracle
etc are taking things anyway):
- readily available high bandwidth comms at a reasonable cost. Note
the recent postings about Cable company activities in this area
though. And of course there's always the NHS Network :-) IMHO high
bandwidth at reasonable cost will soon not be an issue for all sorts
of reasons.
- the realisation of users that this is not fantasy but all eminently
do-able using current and emerging Web technologies (which is where
the big fast developments are occurring anyway so it's not going out
on a limb or backing a dubious horse) and existing systems (albeit
with some Web-enabling work being needed to those apps - but not
complete replacement). As that realisation spreads, it will be
translated into demand for such solutions from your suppliers who
will otherwise sit on the fence I suspect for a whole range of reasons
that I won't explore here.
- the development of Web-based solutions by suppliers, or (an
interesting possibility) add-on DIY developments by individual IM&T
departments to provide Web-enabled links to existing systems/data
warehouses.
And what does the GP need to access all this - a Web browser. What?
you've got one already did I hear you say? Hmmmm. Bit different from
some of those other solutions we've heard a bit about.......
>There are all kinds of issues to
>consider when 'trading' information many of which I would have thought
>were independent of the technology. EDI messaging has to do with
>exchanging structured information in such a form that it can be
>incorporated in the receiving system in a way that enables it to keep
>its original (concept plus context) meaning.
Yes, but if you think about it carefully, many (most?) of those issues
are a result of the messaging/ information exhange paradigm. If
you're actually looking at the remotely held information in situ, then
the remote system will provide the relevant context because it knows
it. Context is then a presentation thing - how the information is
integrated from multiple sources, marked up, laid out and presented
to you, what additional information is incorporated or accesible via
that page etc. You've just got a transient window into that
information not your own permanent copy. IMHO it's when you exchange
or "trade" a copy of the information that the issues bite you in the
bum.
> Am I missing something
>here? How would that be achieved unless, for example, we had universal
>HTML record structures?
Well that's one approach. There's an interim pragmatic approach that
says the current methods of storage of healthcare information are
determined by the suppliers of those systems anyway - very much a
proprietary thing, and it will be years before that changes, if at
all. So HTML provides a means of presenting that information to you
in a nion-proprieary way as a Web page, albeit dynamically created. I
can imagine an SMS system presenting you with a page of patient info
that might look different from the HBO system's presentation of the
equivalent information. THis may or may not be a problem/issue - I've
not thought it through very hard. On the other hand, I guess standard
HTML page layouts could be defined that all suppliers should conform
to when displaying particular types of information.
Where things do get interesting though is if we think about the
EDIFACT standard messages that have been developed, and break them
into two separate components - their content and their transport. It
should be quite easy to translate an EDIFACT message's content into a
Web/HTML form (or set of forms). As far as transport is concerned,
whereas EDIFACT messages are created off-line and dispatched by store
and forward over say X.400, a Web form is filled in in real time by
the user, click the submit button and it's dispatched by http to the
recipient back-end system (eg the hospital) where it can be dealt with
in real time (or batched at the back end) (what - no MHS charge ?!!).
So my view on this is the EDIFACT work has in fact defined for us the
standard content of Web forms that could be used as an alternative
(where appropriate and sensible) for EDI transactions - for example to
make a patient referral and do it by actually being online to the
hospital system so the hospital system can do the necessary field
validation against its own infornation there and then (and show you
the available options) , rather than you getting a message returned
next day saying field 12 was invalid please send it again.
With this approach you've standardised on the EDIFACT content (the
useful bit) but translated into a universal referral Web form, and
dumped the transport side for http/WWW
>
>Not in any way decrying the potential value of this kind of development
>in web technology but trying to understand its potential..
Hope this helps to explain - if you're at Mednet this is a theme I'm
going to be addressing in a keynote speech and would welcome any
discussion then. There will also be some rather interesting demos
I've put together to show the sort of things that are possible using
these technologies, to show it's not all hype and wishful thinking.
I'll be showing the demos at the InterSystems stand at Mednet. Please
come along if you can.
---
Rob Tweed
IM&T Consulting Ltd; Health Web Services Ltd;
M/Gateway Developments Ltd
http://www.hwsl.co.uk/mgw
Tel: (+44) 181 540 1325
Fax: (+44) 181 715 4337
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