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Computers in Medicine

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Intranets can help clinicians share patient information

CareWeb is an intranet that enables doctors to share emergency medical information between several Boston area hospitals and satellite outpatient clinics. Even though each site has different clinical computing systems, distinct institutional vocabularies, and varying completeness of information, CareWeb is able to consolidate medical records virtually. As a result, an emergency care provider, using a standard Web browser, can create a query about an emergency patient and obtain the needed information, according to John D. Halamka, M.D., M.S., of Harvard Medical School and Beth Israel Deaconess Medical Center. Dr. Halamka's work was supported jointly by the Agency for Healthcare Research and Quality and the National Library of Medicine through a cooperative agreement (HS08749).

With this system, the emergency room doctor submits the query to CareWeb, which, in turn, generates a request for information to both the Beth Israel and Deaconess hospital systems. At each site, a site-specific CareWeb program has knowledge of that site's computer systems. It translates hospital-specific information into standard vocabularies and standard diagnostic coding, as well as standard drug and laboratory codes to convey information about the patient's demographics, medical problems, medications, records of allergies, notes, and visits. CareWeb interprets the incoming messages and creates a single, unified presentation that it returns to the emergency provider as a series of Web pages. Tool bars enable full navigational control, allowing the medical record to be scanned using a tab folder-like paradigm.

Security and confidentiality concerns pose a major barrier to sharing patient information in this way. To this end, CareWeb authenticates each CareWeb user and conducts audit trails at each site. Each hospital site server captures patient identification information; the requester; the requester's location, date, and time; and information requested. Security is maintained by a complex series of hardware controls that limit connectivity from outside the institution. Using these "firewalls," network administrators limit system access to users physically located within the campus.

More details are in "Intranets can help clinicians share patient information," by Dr. Halamka, in the November 1, 2000 Ophthalmology Times, pp. 8-13.

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