During a routine exam, Dr. Harry Murrmann, a physician with Aetna US Healthcare, spends as much time reconciling and entering patient records and billing information into three different computer systems as he does with his patient. Murrmann has to punch in a series of ID numbers, codes and passwords on Prudential's and Aetna's systems before obtaining the necessary referral number--a cumbersome procedure he undertakes continuously throughout the day.

With the increasing demand to maximize physician productivity, the drive to integrate disparate clinical, business and support applications in the healthcare sector has never been greater.

The Challenge

"People often forget that healthcare is a many-to-many business. You aren't just connecting a hospital to a handful of its branch clinics but to an array of internal and external data sources and applications," notes Leo Sayavedra, an executive at theSequenceGroup, an IT consulting company specializing in systems integration. Each healthcare provider, he says, is an information node that sends and receives transactions to entities outside its firewall.

Most healthcare organizations are still supporting themselves with circa-1970s technology consisting of applications running on legacy "big iron." Patient records are stored in hard copy; critical patient information is housed in a fragmented fashion on disparate systems that are time-consuming to understand and operate. In short, the healthcare industry's IT enterprise lies frozen in Silicon Valley's version of the Stone Age.

Currently, there is little to no coordination among the various systems that constitute the healthcare IT enterprise. With the advent of the Health Insurance Portability and Accountability Act (HIPAA), however, healthcare organizations have the daunting task of streamlining their operations, consolidating disparate systems and departments, and--most importantly--achieving compliance with federal government mandates. Under law, by October 16, 2003, all healthcare organizations must adhere to a specific format for electronic transactions such as eligibility confirmation, enrollment checks, treatment authorization, referrals and certification.

Healthcare Standards and Web Services

Electronic integration of relevant data such as clinical patient records with billing information has been hampered by multiple, incompatible, proprietary approaches to connecting disparate applications to clinical networks and information systems. This lack of standards has resulted in unreasonable costs for integrating the healthcare IT enterprise. To address the problem, industry members have recently developed several healthcare standards that aim to make integration feasible and cost-effective: