Web services hold great promise for the healthcare sector through cost reductions and improved patient care. Not only have Web services been hailed as the remedy for integrating fragmented health systems and enabling the tracking of biological attacks and epidemics, they also provide new opportunities for service providers and integrators.
Both Gartner and IDC have said that integration and Web services were among the key IT priorities for 2003. Now that we're more than halfway through the year, some examples of Web services in action in the health arena have shown there are challenges still to be overcome if Web services are to reach their full potential.
McKinsey research defines Web services as applications, delivered over the Internet, that can be used through almost any device, whether it's a PC or mobile device. By using a set of common protocols and standards, these applications allow disparate systems to share data with each other, without needing humans to 'translate' the conversation.
The problems
According to IDC research, Web services will eventually define the fabric of computing. However, IDC warns of the disillusionment that generally follows an over-hyped new technology when it emerges. 'Early irrational exuberance could sour perceptions, thus delaying early adoption.'
IDC's US research shows that at the end of 2002, only 5 percent of US companies had Web services projects under way. Within five years, however, that is expected to grow to 80 percent. In that time, IDC estimates there will be $US21 billion up for grabs in work relating to Web services. No figures were available specifically for the Australian market.
Geoff Rohrsheim, managing director of South Australian integrator Strategic Data Management, says there still isn't a good understanding of what Web services are and why people should be considering them.
'There's been a huge focus on how cool the technology is and very few examples on why it's going to be useful, which is typical of IT. We're good at going on about how clever we are, rather than explaining how it can be of use -- particularly to those who've got the cheque books,' he says.
Another problem is that new terminology often disguises old or revamped ideas. The term Web services in healthcare is often interchanged with terms like e-health or e-medicine, and in a lot of ways it is the same thing.
'Regardless of terminology, what the health industry faces is the desire to have information more readily accessible, to have information cross-correlated so that better diagnoses can be formed, and to have information more accurately kept beyond the multiple databases in which it is kept at the moment,' says Kevin Ackhurst, Microsoft Australia's enterprise services director.
Meta Group analyst Michael Barnes agrees that what is happening with Web services and health is nothing new. 'People are already doing electronic health claims, exchange and processing. People have been trying to link doctors and other medical communities for some time.' What is new, he says, is how cost-effective it has become.
'Part of what's gotten people into trouble with promoting Web services is that it's not a silver bullet. It's a huge step forward in terms of evolving towards enhanced collaboration between healthcare providers, insurance companies and other businesses, but it's nothing fundamentally different to what we've been doing in the past.'
The projects
IDC predicts it will take 10 years for Web services to become widely embedded in healthcare, and it will be a process that occurs application by application, project by project.
One project with a long-term vision is HealthConnect, the Federal Government's proposed national network of electronic health records. Trials have been under way since late 2002 in the Northern Territory and Tasmania to test the feasibility of collecting, storing and exchanging patients' records online.
The idea is that, regardless of where the health record originated or where the patient presents to a GP or hospital, doctors can access the centrally stored health record -- with the patient's permission. This is no small task, considering every state and territory in Australia has a different health system, disparate technologies, and players that cling to their proprietary systems hoping for a monopoly in the healthcare industry. Not to mention the challenges of securing sensitive patient data and trying to agree on national standards.
In another project, IBM has developed a Web services application between NSW Health and HCN's Medical Director software for GPs. 'The ultimate aim of this initiative is to have fully electronic health records; helping to proactively manage patients with chronic disease,' says IBM's healthcare consultant, Paul Sulkers.
The health industry, as it is, is not sustainable in the future. Studies predict that baby boomers alone will take up 80 percent of all health dollars as they age, and technology is being called on to play a greater role in improving efficiency.
Greg King from Global Health, the healthcare arm of Working Systems Solutions, says that although the Internet has the potential to provide greater patient self-management, reduce errors, improve health outcomes, and to improve communication between patients, doctors and health professionals, so far a lot of this is anecdotal. 'Outcomes-based research exists for only a few studies and cannot be widely applied across the board,' he cautions.
Health case studies in the US have shown that Web services initiatives have in some cases cut development and programming costs by 50 percent, and halved the time it takes to get a new service for customers up and running.
Integration is one of the biggest IT costs that healthcare incurs. McKinsey research shows Web services can cut the cost of systems integration, as well as speed up the integration process. McKinsey estimates cost savings of 20 percent, mostly through 'reductions in the cost of developing interfaces' between systems.
Meta Group's Barnes says any evidence that Web services can cut costs is mostly anecdotal, but the business case for Web services is sound. 'We're not talking about new investments in new networks, or new proprietary linkages between players in the health industry. We're talking about leveraging the public network that's actually readily available,' he says.
An example of this can be seen in the Web services project under way in two South Australian hospitals, the Royal Adelaide Hospital and the Flinders Medical Centre. Partners in the 'Clinical Risk RADAR' initiative include Microsoft and two integrators, Alcidion and Strategic Data Management.
The project aims to reduce medication errors in the hospital setting and improve the communication of test results to doctors. With more than 12,000 preventable deaths occurring in hospitals each year in Australia and with doctors only ever seeing half of all tests they order, the group decided to tackle both problems at once.
Doctors can now receive alerts about abnormal test results on their PCs or mobile devices, and order appropriate medication and treatment.
It took six months and $120,000 to get the project up and running, with Microsoft's Web services know-how, SDM's RADAR integration layer and Alcidion's risk management system, called SecondScreen.
The beauty of SecondScreen, says Malcolm Pradhan, Alcidion's vice president of research and development, is that it can be layered on top of existing systems; it doesn't try to replace existing systems.
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