From computerized patient records to national resource

Abstract

To help curb constantly rising costs of medical services, healthcare providers in Israel have been busy incorporating computerized patient record systems (CPR) into their organizations since the early 1990s. Our CPR based integrated system solutions (named Clicks) now serve over 90% of primary and secondary medical care professionals throughout the country, covering over 90% of the population across medical fields with all healthcare providers. Online verification of member rights, embedded business rules and medical protocols as well as Preventive Medical Assistance (PMA) rules are incorporated into the system. These, coupled by bi-directional communication to facilitate implementation and enforcement at all points of service and to transmit administrative and focal medical information, have created a firm foundation for carrying out the organization's cost control and expense management strategies. The CPR systems based on these underlying concepts and on token driven data entry methodology have transformed traditional medical work areas into virtually paperless environments. The enterprise wide solutions use dedicated viewports to address the needs and requirements of any medical field, user population and a wide range of medical facilities. Extensive data collection and detailed documentation are maintained universally at all points of service, for the entire patient population. Current applications, based on a distributed approach and local databases with communication to central systems for bi-directional transfer of information, gradually give way to unified databases located on central systems. Two concepts are being implemented: (a) MDC (Medical Data Core), which contains patients' focal medical data as transmitted from the local database at the physician's workstation, and (b) a complete centrally located database, where continuous communication is required from the physician's workstation to the central system, through dumb terminals. This concept entails massive investment in communication capacity and hardware and requires high reliability of all communication transactions at all times. MDC information by contrast does not require open communication lines around the clock, is communicated bi-directionally at predefined points in time or in the workflow, alleviating load and congestion on communication lines. In addition, access, retrieval and display of MDC information is done using standard browsing techniques under known protocols and requires no extra investment for these capabilities.