E-Commerce: Surfer, Heal Thyself: Two Cures for a Health-e Environment

This is a scenario that gives doctors headaches: A patient comes into the office with a fistful of Web pages about their symptoms. About 50 percent of the information is wrong. About 50 percent of the time, the patient strangely trusts the Web information more than they trust their doctor. And, about 95 percent of the time, given the constraints of managed care, the doctor doesn’t have the time to discuss the information with the patient.

Patients get headaches, too. After reviewing a chart for two minutes and a hasty five-minute examination, a doctor mumbles something about long-term and additional test results and scurries off to the next patient. At the next visit, the doctor tells the patient that the insurance company will not pay for most of the treatments the patient has found on the Web.

The $1.3 trillion healthcare industry is a prime target for e-business innovation. It is very large, and growing at the rate of about 6.5 percent a year. By the year 2007, healthcare could represent more than 16 percent of the gross domestic product. It is highly fragmented and, in many respects, inefficient. Above all, almost everybody is unhappy with its current structure.

The Internet is clearly part of the prescription for healing healthcare. According to Deloitte & Touche, 43 percent of the 40 million people who accessed the Internet in 1998 used it access healthcare information. By some estimates, there are nearly 20,000 health-related Web sites.

Health-e Benefits

But, if healthcare is an obvious target for e-business initiatives, the experience of two companies demonstrate how difficult it is to create an "e" revolution in a complex industry. Healtheon/WebMD is the 800-pound gorilla of the healthcare-related e-businesses. iMetrikus is a start-up company, with an ambitious plan to allow patients to take more control of their health.

Healtheon/WebMD bills itself as the first end-to-end Internet healthcare company. Its scope encompasses not just patients and doctors, but also an initiative to electronically integrate the entire community, including insurance companies, employers and all healthcare organizations. To do this, the company has created a sophisticated technology platform that comprises an operational infrastructure and comprehensive middleware architecture for developing, deploying and managing Internet-based distributed applications.

The middleware services leverage industry standards by layering distributed computing middleware services on OMG’s CORBA standard and building on EDI-based, ANSI-compliant data exchange that protects investments in legacy systems. The architecture incorporates Secure Socket Layer and public key cryptography and uses SQL databases. ActiveX and DHTML are deployed in the Internet clients.

Healtheon/WebMD has developed the architecture to be highly scalable, so thousands of third parties can develop their own applications that can be integrated at the user-interface level, the middleware level or the database level. The infrastructure must provide high availability and be manageable. Clearly, Healtheon/WebMD represents a complex, technical undertaking.

iMetrikus’ business model also requires integrating many different players. iMetrikus’ includes three anonymous, secure Web-based health communities, MyHealthChannel, ThePhysicianChannel and TherametricsChannel. Underlying these communities is a powerful, proprietary "knowledge engine" called MediCompass that creates, organizes and manages a longitudinal database of essential patient data, such as practice patterns, adherence patterns, and outcomes metrics. MediCompass transforms the information into valuable tools to be used by patients, physicians and resource providers. Global aggregation of the data through MediCompass creates a robust, worldwide knowledge base of health outcomes, treatment protocols, medicines, procedures, problems and clinical trials.

Unlike Healtheon/WebMD, iMetrikus rejected the three-tier approach of an Oracle database, CORBA middleware and Java browser. That approach didn’t work, says iMetrikus COO, Joseph Condurso, because of firewall and compatibility problems. Instead, iMetrikus makes extensive use of XML. XML, says Jay Evans, iMetrikus’ Chief Technical Officer, is an effective approach in moving data from legacy systems all the way to the desktop. iMetrikus uses almost 100 percent Microsoft-supplied technology from the back-end SQL 7 database, to Windows 2000 Enterprise to Internet Explorer 5 on the desktop. The company has worked with a Microsoft development team and believes the relationship allowed it to come to market faster and with fewer problems.

But the effectiveness of the architecture to deliver information to the desktop is only one of the challenges facing companies that are setting up healthcare-oriented e-businesses. Security is just as important. Users must be confident that their information is completely confidential. To address this issue, iMetrikus has developed a process to ensure privacy, which it calls their Secure Anonymous Information Architecture. It includes four layers of software security, from communication encryption to database encryption, and extensive physical security measures as well.

The experiences of Healtheon/WebMD and iMetrikus underscore the complexity of going "e." A cookie cutter approach cannot work. In healthcare, preserving legacy data and security are paramount. Every industry will learn that it faces its own unique requirements for success.

About the Author: Elliot King is an Associate Professor of Communications at Loyola College in Baltimore, Maryland. He can be reached at (410) 356-3943, or via e-mail at eking2@prodigy.net.

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