September 22, 1997

HEALTH CARE: High-Tech Healing Providers are using IT to help merge systems and keep patients up-to-date By Marianne Kolbasuk McGee n today's world of medicine, finding a community hospital that isn't part of a giant health-care network is almost as rare as finding a doctor who still makes house calls. Local hospitals-as well as independent physician practices, home health-care service firms, and health centers-are being gobbled up by colossal health-care organizations intent on building vast empires. But with every acquisition and consolidatio n, these giants are faced with a major challenge: merging and managing the hundreds of disparate systems they inherit, including systems found in physicians' offices, hospital billing centers, and radiology departments. At the same time, health-care service pro- viders and the companies that supply medical equipment are trying to expand their offerings to become more competitive in an increasingly complex market. Health-care players in the InformationWeek 500 are turning to a variety of IT initiatives, including Web-based information services, data mining, and handheld devices, to make life easier for employees, medical personnel, and patients. For the companies involved in mega-mergers, IT is helping to blend diverse organizations and computer systems and provide an infrastructure on which new services are based. "The health-care market is beginning to look like banking did a couple of years ago," says Jim Anderson, managing partner of Andersen Consulting's health services practice. "Large playe rs acquiring smaller players-and an overall push to leverage information technology." The biggest of them all, Columbia/HCA Healthcare Corp., has relied heavily on IT during its rapid expansion from $1 billion in revenue in 1993 to an estimated $25 billion this year through more than 70 acquisitions. Recent management upheaval and turmoil involving allegations of widespread Medicare fraud haven't kept Columbia from being one of the most IT-intensive companies in the world. The highly publicized problems that have beset the Nashville, Tenn., company this year have not derailed its IT strategy, says CIO Rich Chapman. "IT is the key to our competitiveness," he says, allowing the company to provide better services to hospitals and patients. Columbia, which has more than 1,000 people in its IS organization, expects to spend about $330 million on IT this year. The company had plans this fall to open a "hospital of the future," featuring Internet access in patient rooms and the rollout of new hand held devices for hospital personnel, according to Chapman. But it's unclear what impact senior management changes at the embattled company will have on IT operations or projects. Fitting In Chapman has had his hands full just integrating all of the various health entities-often with incompatible systems-that Columbia has acquired in the last few years. He says the strategy has been to replace systems that don't fit Columbia's chosen platforms with ones that do. In this way, the company maintains common platforms for its hundreds of hospitals, home-care offices, and outpatient services facilities, and thousands of physician practices. This "helps us to integrate the new operations more smoothly," says Chapman. It also helps physicians and other health professionals in any Columbia facility access patient medical records-regardless of whether the patient is visiting a Columbia-affiliated specialist in a nearby town, or has an emergency need for medical attention at a Columbia facility in ano ther state. United HealthCare, a $10.5 billion health-care services company in Minneapolis, has taken a similar approach in merging acquired systems. "Our basic strategy with acquisitions is to collapse the systems of other companies into our own engines," says CIO Paul LeFort, who helped integrate systems when United acquired MetraHealth in 1996. Hungry Audience Even as systems are being merged, health-care companies are using IT, particularly Web-based technology, to transform the way they provide service, share information, and procure supplies. Columbia, for example, plans to open Columbia La Collinas, a 150-bed hospital near Dallas featuring high-tech hospital rooms that will have a PC hook-up to a TV set and, eventually, access to the Internet. "People will go to any length to find information related to their health problems," says consultant Anderson. "They will go to chat rooms, physicians' discussion sites, anywhere to find information on the Internet," he says. And because o f that, health-care providers have a hungry, ready audience. United is rolling out "advanced middleware concepts," which are software "toolboxes" that allow many United applications to be Web-enabled, says LeFort. One goal is to let patients find out whether they are covered for certain procedures by keying in an identification number on a United Web site. This will eventually let the company reduce the number of calls it receives-currently 40 million a year-to its customer-service centers. "Even if we can reduce the calls we get by 5%, that will allow us to save significant money," says LeFort. About 29,000 United HealthCare employees will be able to access information more easily when more applications are Web-enabled on the company's intranet, LeFort adds. United HealthCare's Optum Web site, one of seven the company operates, offers information on chronic illnesses, chat rooms with psychiatrists and other medical providers, and access to nurse practitioners who can answer questions via E- mail. Patients needing to find the nearest United HealthCare specialist or physician can punch in their ZIP codes to access pop-up maps that list local health-care providers. While the Internet is becoming an important tool for health-care companies, privacy and security remain big concerns. The industry is among the most sensitive when it comes to potential Internet security risks and invasions of privacy, says Sue Leboza, CIO of medical equipment maker Baxter International Inc. in Round Lake, Ill. Misused information can also be a problem, Leboza says. For example, physicians participating in chat lines risk having advice to a particular patient be perceived as suitable advice for someone else. Because of issues like these, Baxter is evaluating the use of passwords to give users access to its various Web sites. Still, Baxter understands how crucial the Internet has become to its business. "Communications with customers, suppliers, and partners is vital in being a leader in the health-care indust ry," says Leboza. "And the Internet is key in our business strategy to expand globally." Adds consultant Anderson, "The greatest payoff the Internet can offer health-care companies is the ability to provide patient service like advice and electronic commerce." Many new Web applications in the industry will focus on patient care and financial transactions such as billing, he says. Companies are also using data mining to help improve patient services. United HealthCare, which has an IT budget of about $320 million and an IS staff of 2,500, is using data-mining applications to learn more about treatment and preventative care for patients, says LeFort. United HealthCare's data warehouse is an 11-terabyte database with visualization applications that enable the company to analyze how well patients-based on age, type of illness, and other factors-are doing or will respond to specific therapies. It also helps predict which patients may be susceptible to certain other diseases or sicknesses. Prevention Pays The goal is to help establish better preventative health programs, as well as treat patients with procedures that are likely to produce the best results, based on patients' backgrounds, says LeFort. United HealthCare sells its data-mining research and analysis to drug companies and government agencies such as the Department of Defense and the National Institutes of Health through its Applied Healthcare Informatics division. Health-care product makers are working to improve the way their medical devices provide information to doctors and other medical professionals. Medtronic Inc. in Minneapolis, a $2.6 billion maker of implantable medical equipment including pacemakers, artificial heart valves, and defibrillators, is developing applications that allow data generated by the devices to be accessed by hospital systems "anytime, anywhere," says Richard Gillen, manager of technical development at Medtronic. Compatibility Gillen says the company is building netw ork standards into many of its implantable devices so that the data is compatible with and easily read by hospital computer systems. Medtronic is developing Internet, intranet, and data-mining applications to help in the research of new products. "We want our development people to have access to this knowledge architecture," when creating new features and products, Gillen says. Like the health service providers, Medtronic also sees Web-based technology as "a way for us to remain in touch with each other, and our customers, particularly as we grow globally," says Gillen. "Offering services internally and externally that are built around IT gives us an advantage." Health-care companies are also relying increasingly on the latest mobile computing systems to give workers in the field greater access to medical and patient information. Columbia plans to begin rolling out Windows CE-based handheld devices that will eventually replace many of the portable terminals used by its health-care workers, letting them enter patient data remotely and access E-mail. Anderson expects health-care companies to focus much of their future IT development on creating mobile computing applications, particularly those that help physicians and other medical professionals provide better care for patients. Whether it's for helping to integrate newly acquired businesses or developing new products and services, IT has become a critical component in health-care companies' efforts to be more efficient and provide the best possible services. 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