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This article highlights the statewide success and rapid acceptance by providers in North Carolina of PARTNERS National Health Plan's implementation of a multipayer Internet connectivity solution for providers, employers, and members. PARTNERS is a premier health plan in North Carolina that covers more than 400,000 lives. The company introduced on-line communication to their network of ten thousand providers and has seen the number of on-line users and interactions grow by approximately 25 percent a week to represent more than two thousand providers in the first six months of roll-out. Providers can now look up eligibility and benefits and review and submit claims and referrals on-line; soon they will be able to order and review lab results and perform prescription management. PARTNERS found their Internet solution in HealthTrio's Intelligent Connectivity, which allowed them to create Internet communications without replacing back-end office solutions.

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The Health Insurance Portability and Accountability Act (HIPAA) is intended to simplify administrative processes and improve health information security. There are a number of traditional ways to address the expense and complexities of simplification, but none of them are bargains or beauties to behold: (1) Do-it-yourself encryption; (2) new back-end system purchases; (3) legacy system re-programming; or (4) onerous paper documentation. The good news is that 'second generation' e-health solutions are emerging that act as internal "wrappers" for health plan or provider data systems. They provide both an interface for end-users and a layer of security for organizational information and allow detailed patient-related data to remain at the system owner's physical location. These second generation solutions don't just 'connect,' data, they actually 'understand' the information, and can use data elements to invoke necessary rules, processing pathways, or personalization for specific stakeholders as required by HIPAA.

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The provision of medications to patients is not a departmental task managed by the pharmacy. Rather, it is an enterprise-wide task with management shared by physicians, pharmacists, and nurses. Only automation approaches that integrate all three axes in real time will be able to effectively support the desired goal: the optimal provision of the proper medication to the proper patient at the proper time.

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Historically, home health care has been carried out by independent organizations that provide limited-scope services in a home-only setting. But as capitation takes hold throughout the country, the concept that home care is often the most beneficial way to deliver major portions of patient care finally is becoming clear to health care providers, payers, and patients.

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Interfaces between computer systems are reviewed. An interface establishes a physical connection between two computer systems, a conversational syntax, a format for logical messages passed between the systems, and a data-encoding structure understood by both systems. Interfaces are usually implemented as software modules and consist of three "layers." The physical layer contains the actual physical connection and the hardware, firmware, and software that make the connection work. The protocol layer ensures that the bits of data sent across the interface by the sending system are received intact and in the correct sequence. The logical layer organizes the data to be sent into a form that can be read by the other system. Interfaces can be described by whether they operate in batch or real time, whether they are unidirectional or bidirectional, and the medium used to establish the physical connection (e.g., the exchange of a floppy disk or with an RS-232 serial connection). The real challenge to producing an interface lies in ensuring that the transactions between the two systems are meaningful. An interface engine allows one computer system to interface with several others through a single connection. A good interface has invisibility, reliability, timeliness, flexibility, terseness, and utilities. In planning an interface, goals and the proposed exchanges of data should be clearly defined. The interface should be the simplest one that meets a pharmacy's needs. When the specifications for the interface are completed, the pharmacy should thoroughly test the interface.(ABSTRACT TRUNCATED AT 250 WORDS)

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Over the last few years, health care providers have increasingly recognized that health care is an information business. In fact, the restructuring now being contemplated by many in the context of reform cannot be done without proper information management support. The unfortunate concentration of the health care industry over the last 20 years on administrative and financial data capture has obscured the fact that the important focus should be on patient care and health care operations information. Information on patient care has, unfortunately, largely been relegated to the paper chart and other ad hoc pieces of paper. New systems should focus on health care operations optimization, with specific design features to address failings in the paper system. To be successful, such systems must be integrated and patient centered. This is especially clear in the new enterprise-based world of health care delivery, where patients are the only common factor among venues. Health record professionals, the primary caretakers of patient care information, should be deeply involved in helping institutions move to this new world.

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By almost any measure, it appears that patient-centered integrated information systems with an operations optimization focus contribute significantly to an institution's efficiency, efficacy, and quality. As with any other management enhancement tool, savings will only accrue if the institution manages to the savings. Nevertheless, such savings appear realizable and achievable. User communities, including nurses, physicians, administrators, and others all profit individually and collectively by using such a system. Finally, by providing better quality care and spending less time on clerical work, patients are the ultimate recipients of the benefits of an integrated patient-centered approach.

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In today's cost-constrained health care delivery environment, hospitals are recognizing the need to optimize their care operations to improve the efficiency, efficacy, and service quality of primary health care providers, particularly the medical staff and nursing services, which comprise about 50% of the hospital's total personnel. Because health care institutions are in the business of caring for patients (not for accounts or departments), and because health care delivery largely is a personnel-intensive information industry, operations optimization is supported best by information systems that fully integrate all information concerning the patient. The goal of this is to simplify the job duties of direct care providers. The benefits of an integrated, patient-centered approach include demonstrable improvements in over-all patient care quality and staff satisfaction as well as a significant reduction in costs.

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Today's emphasis on cost containment and quality of care is leading hospitals to widen their automation focus from assisting financial departments to improving operations. Because acute nursing care accounts for a substantial portion of a hospital's personnel and services, developing an information system that places computer terminals at patient bedsides may lead to greater efficiency, among other benefits. Bedside access to information systems can mean that data is more accurately recorded and that nurses' time is more effectively spent on clinical care rather than clerical duties.

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A number of technical issues have been considered in this article; such issues need to be considered in a patient care systems procurement after the philosophic base of the system has been established.

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Computer systems that meet the five principles and support the nine attributes detailed above are most likely to provide optimized operational support to all providers, enhancing efficiency, efficacy and quality of health care. Each time one feature is not included, providers must substitute by decreasing the quality of care delivered, and/or by increasing the quality of care delivered, and/or by increasing the clerical work needed to manage the care system.

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Five key principles for creating effective operations optimization-based patient care automation have now been established: (a) The old system architectures did not provide operations optimization; (b) primary patient care optimization (nurses and doctors) must be the central focus of any effective system; (c) the system must provide a platform that allows for eliminating both the retrospective and prospective (subterranean) paper records; (d) point-of-care data capture, including at the bedside, must be provided; and (e) integration around the patient is critical to success. Systems that ignore these principles will ultimately be doomed to repeat the problems of the manual system. Adherence to these principles opens a myriad of possibilities and provides a road map for how such a system should function. The next installment in this series of articles will address the ramifications of integration in system design and system use. The positive effects that such system designs can have on the realization of demonstrable benefits from system technology will also be reviewed.

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