Records at the Ready

HMA's Web services-based app gives Physicians Access to more patient information in real time.

Health Management Associates Inc. is using Web services to deliver medical information to its doctors and staff in hospitals the company owns across 14 states.

The companys recently deployed Physicians Access application provides real-time access to patient information to some 280 doctors in 44 hospitals in nonurban areas of the Southeast and Southwest, as well as in Pennsylvania. The Web-based application, built with help from Compuflex International Inc., uses a Web services interface to link with HMAs back-end systems, which run on 42 IBM iSeries servers running independently of one another.

"Physicians Access is the beginning of our physicians portal," said Tim Prentis, IT manager at HMA, in Naples, Fla. "It will allow us to get down the road to a totally electronic medical record. What were doing right now with Physicians Access is taking all the electronic documentation thats being produced on all the various ancillary systems—lab reports, radiology reports, various transcriptions in the hospital—and making it available."

With the system, doctors and other approved users can access patient information from any PC or supported hospital kiosk and instantly see demographic, insurance, medical, pharmacological and laboratory data on patients.

Although HMA is run on a decentralized business model, "we have this need to be able to portray things in a more centralized manner," Prentis said. "Weve done some things. Like a couple of years ago, we decided we needed to replace all of our pharmacy systems. We decided to centralize the system here in Naples. The trick was being able to make all that appear seamless with machines all over the place.

"We built a fairly strong communications backbone with our wide-area networking," Prentis said. "So that laid the foundation for Web-based systems to be put together, and we decided to go down the path of using Web services."

When HMA began planning for what would become the Physicians Access application, the company didnt have much Java or Web development experience, "and we didnt even know what Web services were," Prentis said.

"So I ended up hiring five more people with good foundations in Web development," Prentis said. "We re-educated some of our older guys, myself included, and we decided that we would take the approach of being very agnostic with our hardware and software choices. So we decided to build a layer we call the application handler layer. So regardless of what system is underneath that layer we can talk to it."

The system provides standard user name and password access. Role-based access presents users with the patient information that they need to have according to Health Insurance Portability and Accountability Act guidelines.

Compuflex, a Woodland Hills, Calif., software solutions provider that HMA hired in December 2001, proposed using its WebAccel framework as a solution to HMAs ills. Compuflex got HMA up and running with a prototype application, but "it was a love-hate relationship in the beginning," Prentis said. "The base product was under $20,000, but it provided us a lot of utility and got us launched very quickly without being proprietary by nature."

Overall, Prentis said HMA was able to deploy the Physicians Access system for less than $100,000.

Compuflex worked with HMA for about 60 days to develop the first version of the system, essentially the proof of concept, and then HMA took it over and worked another six months on refining the system.

"We taught them how to do Web services," said Cory Isaacson, CEO of Compuflex. "We showed them how to make all [their iSeries-based back-office software] accessible through Web services. Then they spent about 30 days building the Web services interface to the back end."

Despite being unfamiliar with Web services at the beginning of the project, "we started talking about ways to exchange data with different systems, and we decided that using SOAP [Simple Object Access Protocol] might be an optimum way to go," Prentis said. "Web services, utilizing and dealing with our legacy systems, is really what its all about—to be able to get data from old systems and deliver it through the Web. And SOAP and XML are key to the whole thing right now. Were throwing XML around a lot now."

The predecessor to the Physicians Access system "was our old legacy green screen application, which was a real pain for the users to deal with," Prentis said.

Dr. Scott Bohlke, a physician at the East Georgia Regional Medical Center, in Statesboro, said the Physicians Access system makes it "easier to log in, and there is more information available on a screen at one time" than the doctors had prior to the system. The systems benefits also include being "able to follow up on tests from the office," Bohlke said. "Im also able to retrieve past medical information which is beneficial to medical care of patients."

Overall, Prentis said the new system has been well received by the doctors. "But some of the old guys, theyre not going to use it," he said. "They already have a voice-activated system, and its called a nurse. They tell the nurse what they want, and the nurse gets it for them. But the ones that are progressive and want to better utilize their time, theyre the ones that are jumping on the system."