When Medtronic founder Earl Bakken saw the 1931 film Frankenstein, a fascination was born that grew into a conviction that technology could be harnessed to improve life. And so it has. But information technologies dominate some of the newest breakthroughs in healthcare--have you heard of network computers, extranets, thin clients, patient informatics, peopleware, Webtops, or zero administration? If not, you will. Meantime, what do they mean to you? For the most part they promise a return to a simpler, cheaper, easier to run, less scary model for systems development. And also, a returned focus on everyone’s ultimate goal--improving patient care.
The truth about emerging technologies? As our story suggests, it’s as obvious as the scars on Frankenstein’s face: Keep it simple.
Voice, broadcast quality video, 3-D graphics, color photographs and images, animation… it’s not MTV, but it may be the emerging model for the computer-based patient record. The University of Pittsburgh’s Center for Biomedical Informatics’ distributed clinical multimedia environment, called the "Image Engine," is riding the next wave of CPR development (see http://www.cml.upmc.edu). Fueled by National Library of Medicine research grants totaling $2.5 million since 1994, Pittsburgh has integrated clinical text and images--including X-rays, CT scans, EKGs and microscopic pathology--into a single user interface where physicians can point and click from a selection of thumbnail images for micro or macro views, or call up reports on a patient, all from the same screen. Future plans include incorporating digital audio capture and playback. "We want to give clinicians an easy-to-use integrated environment," says Henry Lowe, MD, director of the University’s Clinical Multimedia Lab and principal investigator on the project.
Through the use of internally-developed software agents that aid access to data and images from a number of external and legacy HIS systems, an object-oriented database, low-cost image servers and two sophisticated client applications--one on the Power Macintosh and the other Web-based--the Image Engine compiles information from the enterprise, or off of the public Internet through such services as MEDLINE. A prototype client application for accessing multimedia clinical information over the Internet, WebReport, is also being tested. Image Engine has already generated a great deal of outside interest and will soon be installed in the University’s Cancer Institute. "Everyone who sees it wants to know how they can do it," Lowe notes.
A Simpler World in Store?
When we talk about "emerging technologies," a picture comes to mind of a white-coated technician--even Dr. Frankenstein himself--toiling away for hours, days and years on end, tweaking complex mathematical equations in stuffy supercomputer labs.
Yet emerging tech in healthcare is often as simple as generating widespread clinician use of e-mail--a technology that has been around since the 1970s. And all the fanciful talk of the mind-boggling realm of the World Wide Web is based on the simplest communications standards and protocols known to the computing world to date--technologies that also have been in place for many years. Even the desktop PC--with all its bells and whistles, CD-ROM and floppy drives, modems, sound and video cards--is being whittled back down to a new ’90s version of the dumb terminal, called the "Network Computer." Gone are the days of ponderous, proprietary and costly mainframe environments; hello microworld, ubiquitous GUI WWW interfaces, and anywhere, anytime, anyhow capabilities at rock-bottom prices. Media-hyped myth? The reality, at least for healthcare, lies somewhere in between.
Object Oriented Takes Hold
Object-oriented development, graphical user interfaces, Java, hypertext links, Web-ready applications--these are becoming near requirements for new software products: They promise ease of development, use and maintenance. Object-oriented methodologies are nothing new, but the concept has taken off over the last two years and several categories of the technology exist today. "Object orientation holds real promise to help with the integration problems in healthcare," says Dave Garets of First Consulting, Filer, Idaho, who entered healthcare in 1990 after 13 years with AT&T.
As Garets explains, object brokers or "wrappers" surround legacy applications to make them accessible by newer applications, allowing the integration of legacy technologies into new systems. Object technology is helping to solve the ongoing problem that arises as hardware advancements outpace software technology. "Some of the Java and object tools are allowing software to catch up with hardware," he says.
At the forefront of the object-oriented movement is Sun Microsystems and its heavily-promoted Java development environment. The widespread acceptance of Java, an 18-month old technology, is astounding yet makes perfect sense to many in the software development world; Sun estimates that 450 independent software vendors are developing with Java. According to the "write once run anywhere" mantra, Java applications can run on any computer platform--from Microsoft Windows to UNIX to Macintosh and even to a 3270 terminal. Its cross-industry success has begun to trickle down into the ranks of IT firms targeting healthcare, such as Software Technologies Corporation, HSII, SMS, Alltel, Compucare, Oacis, Lawson, Siemens and Philips--all of which are using Java in application development projects.