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Patient Safety and Quality Healthcare
July / August 2005

Q & A

The Future of National Healthcare Infrastructure

Jim DemetriadesJim Demetriades is founder and CEO of SeeBeyond Technology Corporation. As a technology visionary and business strategist, Demetriades originated SeeBeyond's continuing mission of helping customers manage the flow of information across all systems, applications, enterprises, and government entities on a global basis. Before starting SeeBeyond in 1989, Demetriades worked as a senior consultant/chief developer for Pacific Healthcare Systems, and designed software systems for the insurance industry at Information Concepts, Inc. He holds a bachelor of science degree in computer science, with a second major in economics and a minor in marketing, from Loyola Marymount University, Los Angeles.

PSQH recently talked with Jim Demetriades, CEO of SeeBeyond Technology Corporation, about efforts to create healthcare infrastructures that make patient medical records available across organizations, regions, and countries, both in the U.S. and internationally.

PSQH: You've been involved in healthcare IT standards since the 1980s. Can you describe your involvement in developing the enabling technologies and standards that support today's healthcare infrastructure?

Demetriades: Twenty years ago, a variety of healthcare organizations across the United States realized that there was no standard methodology to communicate and share information. Realizing there was no organization responsible for establishing these standards, I became involved in founding Health Level 7 (HL7), now one of several American National Standards Institute (ANSI)-accredited Standards Developing Organizations (SDOs) operating in the healthcare arena.

As one of the original chapter chairs, I helped to develop standards to define how all types of information in a healthcare organization is gathered, with the goal of providing flexible, cost effective approaches to interoperability between healthcare information systems. In parallel, I founded Software Technologies Corporation (STC), which is now known as SeeBeyond Technology Corporation. The company was founded in 1989 on a mission of enabling the seamless flow of information on a global basis. With that in mind, my team set out to develop a product that complied with the HL7 standard and that would allow healthcare organizations to gather and share information electronically.

The timing was perfect. As a majority of healthcare organizations in the United States began to adopt the HL7 standard, we began to build our customer base, which quickly grew to hundreds of hospitals around the country.

And that's literally how SeeBeyond began; with the idea that we could reduce the cost of integration for healthcare organizations — by as much as 80%. In those days, when you bought a new software application at a hospital, the cost of integrating that application with all of your existing systems was actually more than the application itself. The value of reducing integration costs remains invaluable even today.

Today the U.S. healthcare industry is working on putting in place, within the next decade, a national healthcare infrastructure or National Health Information Network (NHIN). A key enabler for the nationwide adoption of a 'common framework' for the electronic exchange of health information is compatibility of standards to allow for information exchange and interoperability between systems. By applying healthcare architecture and developing information technology standards and infrastructure, both patients and doctors will benefit. It will lead to enhanced patient care, operating efficiencies and it will contain escalating healthcare costs.

PSQH: Now that standards have been developed, and integration is becoming more widespread within the healthcare industry, what is the main challenge healthcare IT faces today?

Demetriades: Clearly one of the biggest challenges — yet could and should be viewed as an opportunity is the need to establish an electronic medical record (EMR) to provide a historical view of patient data across the continuum of care. Enabling individual health records helps to define how historical patient information should work with new standards and pushes organizations to share information — herein lies the technological challenge.

In order to be successful in creating a sound infrastructure that will support EMRs, healthcare organizations and government bodies alike must invest in establishing new processes and enabling technologies to support informationsharing and interoperability. With a population of people that are living longer, we are facing unprecedented challenges in the medical industry. It is imperative that an advanced technological and procedural infrastructure be put in place on a national scale to ameliorate the risk of poor quality care and to reduce cost. A comprehensive solution would not only touch the underlying technologies but in fact would touch the procedures and processes necessary to administer a hospital and to apply appropriate care.

PSQH: Are integration and national healthcare infrastructures also being adopted globally?

Demetriades: Most of the western world is becoming very interested in this type of macroeconomic issue in fact every country in the world is dealing with an aging population, which is living longer and requiring more care then in decades past. SeeBeyond started working with Australia over 10 years ago to support the establishment of a National Health Information Network (NHIN), and other countries have followed suit including the United Kingdom, Luxembourg, Ireland, France, Germany, Italy, Sweden, Finland, Norway, Austria and Canada.

In the United Kingdom for example, SeeBeyond's Integrated Composite Application Network Suite is being deployed by the National Programme for IT within the U.K.'s National Health Service (NHS) and acts as the "spinal cord" of the country's information infrastructure, enabling healthcare practices to share information. Within the NHS, SeeBeyond software will be used for integrating patient information for nearly 50 million members across 250 hospitals and 600,000 medical practitioners, encompassing 10,000 systems across 40,000 sites. The idea is that organizations can share the information they have, on a permission basis, without having to comply with a specific structure mandate.

PSQH: What about healthcare infrastructures on a regional scale?

Demetriades: Underpinning the NHIN are regional health information organizations (RHIOs). RHIOs are collaborative entities that facilitate the development, implementation, and application of secure health information exchange across regional care settings and facilitate interoperability on a national scale. RHIOs are in the early stages of development and adoption in communities within the U.S., but paramount as a vehicle to support IT investment and promoting the federal goal of interoperability. Eventually, the goal is to have every American covered by a RHIO.

SeeBeyond provides the unique healthcare integration platform to allow organizations to link seamlessly together locally within a RHIO, which will eventually lead to interoperability across RHIOs and then across the nation. Blue Cross Blue Shield of Massachusetts (BCBSMA) is one example of a healthcare organization that SeeBeyond has helped enable interoperability through RHIOs. BCBSMA is leveraging its partnerships with the State of Massachusetts, other Massachusetts payers, and the Massachusetts provider networks to share information collaboratively. Utilizing SeeBeyond technology, BCBSMA is expanding into new channels, improving patient satisfaction, and sharing access to legacy systems through this regional network. As a result, they are benefiting from reduced development costs and significant competitive advantage.

PSQH: How will organizations benefit from national infrastructures and EMRs?

Demetriades: With a national infrastructure, the ability to evaluate patient and clinical information and incorporate it seamlessly, quickly, and inexpensively into best practices within a healthcare organization and ultimately improve the quality of patient care is priceless. For example, we have one customer who was able to virtually eliminate the need to pull "paper charts" in their emergency room. With 95,000 patients, at 35 dollars per chart pull — you can see the savings alone are substantial and will more than pay for the system in a short period of time.

The process for admitting patients to a hospital, for instance, varies widely across the industry. The right infrastructure enables a facility to design a "best practices" process such as admissions and patient history, and share the resulting application with other facilities. For example, information gathering on a patient's treatment history may not be as thorough in an emergency room as it is in an internist's office. However, the same patient may visit both within a short period of time in which information from the patient's internist may be critical to the emergency room staff.

With EMRs, each doctor would have the advantage of knowing a patient's complete medical history and can make better decisions based on readily available qualitative information. In another example, if an operation is scheduled, a physician can determine whether the patient may have reacted negatively to a specific medication in the past that may put him or her at risk during a particular procedure. The bottom line is that with the availability of EMRs, there is an opportunity to improve common procedures and thus improve the quality of care provided.

Bottom line, the key to a successful U.S. healthcare infrastructure is a universal desire to improve the quality of patient care and reduce the overall cost of healthcare. That desire exists today. Our customers are leading the charge, and with the support of SeeBeyond, are committed to making electronic medical records a reality.

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