Today's hospitals, clinics, doctor's offices, insurers, and government agencies have more sophisticated technology and information to use in providing quality health care than would have seemed possible even a few years ago. However, tapping this gold mine of data and technical capability to deliver the most effective, efficient patient care remains a challenge for this unique and critical industry.

The two key players in the health care industry - the providers and the payers - share some issues. Both groups face tremendous pressure to improve patient care while mitigating the effects of skyrocketing costs. Both must meet increasing regulatory requirements related to privacy, security, and more.

Using IT to address these critical issues is challenging because key systems and information are often isolated. The result is a limited ability to share and synchronize data, particularly on the fly when critical patient care decisions are made. Administrative reporting is complicated and can be labor intensive, with much of it manual (particularly in provider settings) and thus slow, error prone, and duplicative. A lack of comprehensive, quality data adversely affects patients daily.

The efficient sharing of valuable data is difficult, whether between providers and payers or groups of clinicians within a single health care organization. For example, a hospital's diagnosis, patient information, lab testing, and pharmacy systems are typically not tightly linked. This lack of integration and reliance on paper, fax, mail, and EDI is very costly and allows errors to go undetected, often until it is too late.

To help address these financial, treatment, and regulatory challenges, health care entities need to integrate, within and beyond their own organizations. For some institutions this may be a matter of survival. They need to become on-demand enterprises - organizations in which processes are integrated across all groups and partner institutions, allowing them to respond with speed to patient's and professional's demands, research needs, and regulatory requirements.

IBM works closely with all types of health care organizations to address their critical challenges and help them become on-demand organizations. This experience with health care customers guided IBM's creation of middleware solutions designed specifically to address some of the industry's most pressing challenges. The solutions are part of IBM Software Group's effort to deliver industry middleware solutions - a strategy based on customer buying behavior that indicates they prefer to buy solutions designed for their industry. Each industry middleware solution contains software from IBM's WebSphere, Lotus, Tivoli, DB2, and Rational middleware brands, combined with industry-specific middleware, applications from independent software vendors (ISVs), and industry-expert services.

The health care solutions are for providers and payers. IBM's middleware solutions for providers are "designed to address cost and regulatory issues individually and to help build an information management structure," said Tony Bosselait, IBM's Worldwide Software Sales Business Unit executive - Public Sector, Health care. "A customer can start with one solution addressing a given challenge and build out to others as they need to in an open, integrated infrastructure."

For academic medical centers, public health care agencies, and hospital networks, the IBM solutions are coordinated within the Aligned Clinical Environment. It has been "architected so that you can easily and incrementally add functionality that responds to the issues the clients want to tackle, while retaining their existing infrastructure," said David Epstein, director, Solution Development, Public Sector, IBM.

For academic medical centers, public health care agencies, and hospital networks the IBM solutions are coordinated within the Aligned Clinical Environment. It was "designed to add functionality but not add to the customer's infrastructure," said Epstein. "It requires no radical shift in technology and there is a growth path. Our solutions can be integrated into the existing infrastructure starting with any issue the customer wants to tackle."

"The environment guides how IBM designs, builds, and operates an integrated clinical and research information management infrastructure, allowing these clients to access and/or aggregate data that already exists to provide better patient care and create sustainable competitive differentiation," said Lynn Everitt, IBM Software Group Market Segment manager, Health care. "It addresses clinical and research integration, clinical performance improvement, disease monitoring and public health surveillance with four middleware solutions."

One of those solutions, the IBM Middleware Solution for Healthcare Collaborative Network (HCN), provides accelerated integration of disparate applications to improve the availability of integrated clinical information. This secure solution provides a user-friendly interface for specifying what kinds of clinical patient data should be monitored across an institution's various clinical systems. The results are improved quality and safety of care, improved staff productivity because they can focus on event exceptions to care protocols, application/information integration from a customer view, and increased clinician satisfaction and utilization of IT systems.

IBM's goal in developing the HCN was to provide a unified infrastructure for the transmission of clinical information from a local to a national scale, according to Epstein. To determine the appropriate architecture, the developers worked with three U.S. government agencies - the Food and Drug Administration, the Centers for Disease Control, and the Centers for Medicaid/Medicare Services - that needed similar data for different purposes.

"We also worked with hospitals to make sure we could automatically get this data," said Epstein. "Despite the challenge of their very heterogeneous environments, we were able to build a neutral integration point with the required security features."

New York Presbyterian Hospital used the solution to move from paper to a network for data exchange. The new system, which includes pre-existing applications and infrastructure, has reduced the complexity, time, and cost of data sharing, and is flexible enough to adapt quickly to changing requirements. As participants in the Healthcare Collaborative Network increase, the solution will allow hospitals, insurers and the U.S. government to respond rapidly and decisively to routine or unexpected events and identify patterns and trends in their rapidly changing industry.

"With all the sophisticated technology found in a modern hospital, the lack of coordination among hospital systems seems almost primitive," said Herbert Pardes, M.D., President and CEO, New York-Presbyterian. "A seamless, integrated network of information could do as much to protect patient safety and improve care as many other medical breakthroughs."

Many hospitals have disparate clinical and hospital information systems. This means they are often unable to provide clinicians with real time actionable data or correlate data from multiple applications. Furthermore, there is a tremendous amount of redundancy in patient and clinical information and managing paper-based processes is costly.

The IBM Middleware Solution for Healthcare Clinical Decision Intelligence can help improve quality of care and safety by decreasing the time to clinical diagnosis and treatment and reducing safety risks posed by a lack of information. By aggregating data from multiple, a disparate database, this solution improves decision-making by providing physicians to tools and the data necessary to practice evidence-based medicine.

The Clinical Decision Intelligence solution helps clinicians be more responsive and improve medical outcomes by providing real-time secure access to consolidated patient and research data. It also enables the data for analysis and profiling on such issues as management and cost containment. The solution also integrates people, processes, and information regardless of device used or location.

H. Lee Moffitt Cancer Center & Research Institute, a leading cancer center, plans to use the Collaborative Clinical Portal solution to unify its legacy systems, provide collaborative systems worldwide, and provide access to its enterprise data warehouse and key applications. The solution, consisting of IBM WebSphere Portal software and hardware, with Lotus Workplace Team Collaboration, has integrated business processes and information. It has helped improve patient care, helped physicians collaborate around the world, unified access control and unified the system look.

The IBM Middleware Solution for Healthcare Clinical Decision Intelligence can help improve quality of care and safety by decreasing the time to clinical diagnosis and treatment and reducing safety risks posed by a lack of information. By aggregating data from multiple, disparate applications, the solution improves workflows, straight-through processing, process monitoring and reduces processing costs.

The Clinical Decision Intelligence solution helps clinicians be more responsive and improve medical outcomes by providing real-time secure access to patient and research data. It also provides in-depth prospective and retrospective data for analysis and profiling on such issues as management and cost containment. The solution also integrates people, processes, and information regardless of device used or location.

The Mayo Clinic in Rochester, Minnesota, used the solution when teaming with IBM on its Computation Biology Collaboration Project. The Mayo Clinic had vast stores of critical patient and research data, including detailed genetic, genomic, and proteomic data that was useful to its physicians and scientists on a daily basis. Unfortunately, the data existed in various places and in various forms throughout the clinic, making it difficult for employees to access. The Mayo Clinic wanted to consolidate the information into a centralized data warehouse.

The initial phase of the project was the creation of a data warehouse using a DB2 Universal Database and WebSphere technology running on IBM eServer pSeries 650 and 690 servers running AIX. The complete data warehouse is housed on an IBM TotalStorage Enterprise Storage Server. To enhance usage of the data warehouse, which stores information for more than 4.3 million patients, IBM developed a Data Query Abstraction tool.

The Mayo Clinic now has a foundation for using genomic data to further study illnesses and their treatments. Specifically, the solution provides the ability for nontechnical personnel to run complex queries, to express queries in end-user terms, and to define queries without regard for physical data representation. It also provides support for durable queries that can adapt to change in physical data schema and the clinic can manage query and result sharing.

The Mayo Clinic also used parts of the IBM Middleware Solution for Healthcare and Life Sciences Clinical Genomics, which makes it easier to access and analyze increasing amounts of data. The solution improves collaboration and provides an environment for tapping into and analyzing genomic data for use in research. It also improves application and information integration by linking multiple data sources into a single accessible data warehouse. For example, the solution can decrease the time it takes to develop new drugs by providing an environment for capturing clinical patient data for reuse as the basis for directed drug development research.

Overall, the Clinical Genomics solution helps accelerate targeted, innovative, clinical, and basic research by optimizing the capture and integration of phenotypic and genotypic data and enabling secure, cross-institutional sharing of data for collaborative research. The Clinical Genomics solution provides an environment for capturing and integrating clinical patient data with high throughput research data in order to identify and validate novel therapeutic targets, conduct more focused clinical research, and ultimately revolutionize the way diseases are diagnosed and treated.

The payers in the health care industry are also facing a critical need to improve service while keeping rapidly rising costs as low as possible. In the face of these budget pressures, they need to improve organizational performance with existing resources. In addition, there is a scarcity of skilled workers and manpower is costly, existing applications are difficult to learn and application consolidation requires major deployment and retraining costs.

The IBM Middleware Solution for Healthcare Payer Services Portal is designed to improve business and IT operations efficiency. It improves organizational performance by making it easier for customer services personnel to learn and use legacy and new applications through a consistent role-based interface. It helps reduce administration costs with the secure framework where employees can do their work from anywhere, at anytime, faster (providing single sign-on and secure application access.) It also provides collaborative and workflow capabilities to streamline and speed up business processes. The result is improved workflow, ease of doing business, integrated customer view and potential for increased market share.

WellChoice, the largest and oldest health insurance company in the State of New York, used the solution to consolidate disparate membership, billing and claims processing operations into a single enterprise system. Their goal was to improve customer relationships and provide a self-service model. Empire used IBM software and hardware to launch four portals for members, physicians, brokers and employers.

The result was reduced operational costs (from six legacy systems to two), centralized membership, billing and claims processing activities combined into a single set of business operations, and enhanced delivery of services to different customer groups.

IBM's Middleware Solution for Payer Plan Administration also addresses the need to cut the cost of administering customer interactions. Payers have difficulty cutting these costs because of a lack of usable data to manage them. Insurance risk and pricing can't be modeled because data is incomplete, not detailed, or not available until too late. In addition, customer service is not adequate because the representatives don't have the right information at the right time.

The Payer Plan Administration solution automates processes and creates an efficient business environment to reduce costs. It draws out transaction information to improve administrative and medical expense management. It also allows payers to respond to sponsor and member demands for excellent self-service and improved access to decision-making information.

It was used by BlueCross BlueShield of South Carolina to improve the efficiency of their claims processing and provide customers with self-service capabilities. IBM's solution allowed BlueCross to furnish its clients with data concisely via the Web and MQSeries enabled them to bridge the gap between different computing platforms to provide transparent customer facing applications. The result was the creation of a sophisticated data processing center that can adjudicate all claims in real-time.

"It's an example of the type of solution many health care organizations need, said Stephen K. Wiggins, CIO, BlueCross. It's been through this working partnership that our companies have developed a solution in health care that anticipates and exceeds marketplace demands."