Portals Join the Medical Team

Portals are reaching beyond e-business and finding a place in the operational aspects of various markets. One vertical space that seems suited for this development is the field of medicine.

For years, physicians have wanted easy, instant access to the latest medical information. Doctors have always been mobile workers who ministered to the sick wherever they were. Doctors also need to stay informed on the latest developments in medicine so they can keep pace with the discovery, evolution and treatment of diseases.

As the profession of medicine evolved, various providers of information developed seminars to help doctors stay in touch with new information as well as each other, but the seminars often forced doctors to leave their busy practices to attend. Video conferencing has proven to be imperfect solutions due to technology limitations.

In contrast, portals, available through standard Web browsers, are beginning to offer clinicians and medical institutions a tool better suited for their unique needs.

The Johns Hopkins University School of Medicine in Baltimore is at the forefront of medical institutions implementing portals. The school has a long tradition of innovation, beginning with the opening of the Johns Hopkins Hospital in 1889, the first hospital in the country to have central heating.

Too Fast for Print
Clinicians usually carry pocket-size manuals that contain condensed information on infectious diseases and references to recent research. The Pocket Book on Infectious Disease Therapy by Dr. John G. Bartlett--chair of the infectious disease department at Johns Hopkins--gives clinicians advice on which antibiotics to use for specific infectious diseases. Like all books, however, its information goes out of date almost as soon as it reaches doctors.

Since The Pocket Book was last updated in 1998, the field has experienced dramatic changes--often on a monthly basis. For example, emerging issues regarding resistance of diseases to antibiotics have given rise to new remedies. No edition of Bartlett's book provides the latest updates. According to Sharon McAvinue, director of program development for Internet initiatives at Johns Hopkins, the institution's new antibiotic portal will bring clinicians the most recent treatment information for the first time.

In the antibiotic portal, the printed version of Bartlett's book will be replaced with a Web page that can be updated whenever changes in antibiotic therapy take place. In addition, the portal will have an interactive component that will permit clinicians to seek advice on complicated cases directly from Bartlett or his colleagues. According to Dr. Walter Atha, director of the infectious disease Internet project at the university's Department of Medicine, "If the clinician has a particularly difficult question, we're going to ensure that the question gets answered."

Like the hard copy of The Pocket Book, the portal also will provide practical information to the clinician. "One of the things we address is whether someone has to be admitted to the hospital," Atha says. "For example, in the case of community-acquired pneumonia... one of the algorithms we will put on that page is derived from the IDS [Infectious Disease Society] guidelines for treating pneumonia, which include criteria for hospital admission."

On the academic side, researchers will be able to gather information from the field that was inaccessible in the past, such as insight into clinicians' thought processes gained by means of interactive questionnaires. "The portal gives us the platform for starting to understand how we [researchers] impact behavior, how doctors reach critical decisions and why they make these decisions," says McAvinue.

Hands-free Knowledge
The next step in development will be to make the antibiotic portal accessible to wireless devices. AppliedTheory of Hauppage, N.Y., is providing a Web infrastructure through which the portal can use technologies such as Oracle's Portal-to-Go to translate existing content into wireless formats, such as the Wireless Application Protocol (WAP) and the voice standard VoxML. Developers hope that clinicians eventually will be able to access the Hopkins portal while driving to a hospital or HMO--without taking their hands off their steering wheels. In addition, physicians will be able to have detailed information such as research studies delivered to a desktop PC.

Johns Hopkins anticipates that in its final form, the antibiotic portal will provide a closed feedback loop. Clinicians will be able to obtain current information on antibiotic therapy that will improve the quality of patient care. In turn, researchers at Hopkins will acquire information on antibiotic use that can help them to improve public health by discovering resistant strains of bacteria sooner and minimizing over-prescribing by physicians.

Because this initial adoption of portal technology at Johns Hopkins is occurring at one of the nation's most respected healthcare research and treatment institutions, it has a good chance of trickling down to other levels of medicine.

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