First Published in Knowledge Management World, February 23, 1998

Lotus Notes is the Physician's Rx        

A Healthy Dose of Domino is the cure for Healthcare provider

Hospitals continually face two challenges. The first is to provide the best patient care possible. The other challenge is to garner the attention of the physician partnerships to join the hospital's network of providers. If a hospital cannot attract and keep these 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. The saying of "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 it becomes a win-win situation for 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 the doctors can make knowledgeable decisions?

This was the task that faced Crouse Hospital in Syracuse, New York. But there were other questions that needed answers:

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

In the past, HCDS's primary means of offering physicians access to patient information was via 3270 emulation to their 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 end-user accidentally (or by their kids since some physicians wanted access from their home PC). These were the problems placed on the shoulders of HCDS's 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 approximately two years ago. At that time, most physician access systems were client/server based and thus required more support than what 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.

It was time for a new approach.

Chuck Fennell, VP of Health Systems at Health Care Data Systems, tackled this challenge using Lotus Notes Domino solution with the help of integrator IKON Office Solutions of Buffalo, New York. Now physicians need just a modem and a browser to access the new Physician Access System called EntryNet.

With Notes acting as a metaserver, pulling data from several different applications and server platforms, physicians now have one easy to view access point for the most up-to-date patient information available. Using the Lotus's 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 an 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's Domino-based Intranet can provide support to all 800 physicians with only an inexpensive or free browser on their PC.

Adding additional users is as easy as giving them an ID and password. No more visits to the physician's offices to load (or reload) 3270 emulation software. Since most physicians already have a home PC with a Web browser installed, end-user training is reduced as compared to 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. The Domino solution is also offering a more scalable solution than other physician access systems.

HCDS can move to either faster or multiple processors without having to re-write the application if the need arises. EntryNet also allows them to adopt new features from Lotus as they become available.

HCDS would like to expand the system to include streamlining communications with the insurance companies to further reduce the administrative burden of their members.

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 also looking into a new messaging system within their organization. Notes strong e-mail platform fit HCDS requirements.

Capturing all the information from these disparate systems and allowing the physicians to turn it into knowledge for better patient care has proven to be a success based on early feedback for EntryNet. HCDS is so confident in Entrynet, that they will be marketing it to other hospitals around the country.

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

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Stephen Goodfellow is President of Access Systems, Inc., an independent consultancy in Knowledge Management, Technology Assessment and Marketing Strategies for vendors and end-users. Steve can be reached at (315) 682-1188 or via e-mail