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Limited Access Webways

February 1, 1998
by Charlene Marietti
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Build private roads behind the firewall to run Web-based applications, it’s an intranet; open a gate to run on the public thoroughfare and the roadway becomes an extranet. Sounds simple, but actual configurations are much more complex and sport an incredible number of permutations. Produced by the same technology that has brought us the mother of all network applications--the Internet--intranets and extranets guard the organization’s data doors, opening them as much or as little and to as few or as many as the organization chooses. How organizations define intranet and extranet networks--who can access internal information and how much--determines the final format.

Active intranet and extranet business models are now realities in many healthcare organizations. Currently, most address the basic problems of internal communications, information resources and marketing. The intranet is most often used for administrative and patient-related data access behind the relative security of a firewall; users outside the firewall access corporate information via an extranet configuration. Usually implemented first for physicians and staff in remote locations, extranets can also support access to a wider audience with patient-specific information or generic information. Quite new to the healthcare venue is the idea of marketing, but a review of hospital home pages reveals that competition among providers is fueling such a drive. According to IBM market research, about half of all hospitals in 100 of the leading U.S. population centers have an Internet presence.

Business networking communications are evolving: intranet vs. Internet/extranet are replacing LAN vs. WAN decisions. "The capability to have a common platform is a quantum leap in computing," says Gail Gulinson, vice president, health networking solutions, IBM’s Global Healthcare Industry, Waltham, Mass., but the technology options are numerous. When it comes to planning and implementing an intranet or extranet application, she says, "The most successful are those who have identified and understand the business problem and how an intranet/ extranet installation will add value to the equation."

Many healthcare organizations are already using electronic commerce for information management, supply ordering and supply chain management; now they are beginning to blend care issues with traditional business and financial issues. In the more fluid business environment where customers are voting with their feet, providers and payors alike are looking at ways to raise consumers’ levels of satisfaction. Many payor plans are adding customer services. In some, for instance, members can access disease management information with passcode-access as well as perform more mundane tasks such as updating personal information.

Extranet requires more security
While the intranet operates in relative security, the extranet brings new challenges, particularly for privacy and for security--major issues in installations. The combination of additional security layers and third-party devices usually brings more security to the table than ever was in place before the idea of Web-based access. "In most cases intranets are more secure than the current system. In addition to adding operating layers, intranets have audit trails--unknown in most traditional healthcare environments," notes Gulinson. Most businesses want to begin with a very basic, very modular and very scalable system and, although intranets are commonly built first in healthcare, she says, it isn’t long before the organization adds a front end to provide generic access to the Internet through the firewall.

As payors and providers look to the extranet phase of development, many see the extension as fairly noninvasive--where they can continue to operate in the same general patterns while adding value to their members. She points out that most extranets do not support data access at the patient-specific level--at least not initially. The VHA has begun an extranet project with IBM to link VHA’s 1,400 healthcare organizations with each other and with key partners that include physicians, insurers and suppliers. Although the VHA has announced plans to share best practices in patient care, this refers to categories and disease states--not patient-specific information.

In a time when Internet access and data overload can result in not just conflicting, but sometimes erroneous information, many healthcare organizations are responding with "branded" information, that is, information that carries the hospital’s seal of approval. "Content is king," says Teresa Choi, manager of the Virtual Hospital project and the Electric Differential laboratory at The University of Iowa Hospitals and Clinics Virtual Hospital, Iowa City, Iowa, regarding the philosophy of quality information. Patients seem to agree. The Virtual Hospital draws information seekers not only from its regional pool, but visitors from all corners of the globe. According to Choi, more than 50 percent of people accessing the site are looking for patient information; the remainder are seeking information on healthcare providers.


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