The term 'web portal' was an IT buzzword in the late 1990s and while use of the term declined in the IT industry, it has been on the rise in the NHS. Everyone, it seems, is looking to develop a portal: patient portals, clinician portals, management portals explains Dr Joel Ratnasothy, medical director EMEA for Caradigm UK.
The problem is that a portal in a healthcare IT context is a loosely defined term to describe a web page that displays information retrieved from other systems. The systems it connects are ideally 'best of breed' applications that manage specific clinical tasks such as medical imaging or blood sample testing. But the broader IT industry no longer talks about web portals, but it is talking about 'big data'. Yet some hospitals may think that a web portal will help achieve the analytical benefits promised by big data, but it won't. It won't because, much like the early internet, most web portals are read only (e.g. web 1.0). They collect the data as a snapshot in time, present it to the user and then it ages quickly. In addition, most portals are built to be viewed using a desktop web browser and do not naturally adapt to being viewed on mobile devices. The user is restricted to viewing the data on a desktop at a fixed location, not at the place where they want to see it—at the patient's bedside.
How did we get here?
If we reflect on the evolution of hospital IT systems, the need for their creation stemmed from the driving force that is the hospital ward round. As science and technology progressed, diagnostic departments like radiology and pathology grew to service the increasing demands made on them from the ward round. These departments had information challenges and IT systems that were built to support them. But each department only saw a single aspect of the patient record in a single part of the clinical process. Each system held information that was only a part of the overall patient's health picture, and copies of results and physical images needed to be sent back to the ward to be stored with the patient's master paper record, which ultimately remained the single source of the truth about the patient. If the use of the portal is to survive and flourish it needs to become that single source of the truth. And it needs to evolve just like the internet did, from read only 'portal 1.0' to read and write 'portal 2.0'.
Portal 2.0 - benefits for patients, clinicians and managers
The goals of the clinician are to identify, diagnose and treat disease and the majority of activities geared to achieve these goals are generated during the ward round, next to the patient. By enabling administrative tasks to be carried out closer to the patient, the most current, complete and accurate information can be made available to the clinician when it is needed most. Analysis or decisions made by the clinician can be recorded at that point in time and if further follow-up is required, it can be requested there and then—no one should have to spend additional time on administrative tasks such as ordering tests or requesting investigations once the ward round has finished.
One of the benefits of supporting clinicians' workflows in this way is that it can garner greater adoption in the clinical setting. Give someone a tool that helps them do their job more efficiently and they will keep on using it more and more. The benefits of the 'Portal 2.0' for patients and clinicians are obvious and can even benefit hospital managers. There are commercially available stand-alone applications that provide hospital managers with information such as bed occupancy or re-admission rates, however, hospital managers require aggregates of this type of data to efficiently run analyses and workflows at the request of clinicians to allow such clinicians to better manage their individual patients. The beneficial result is that clinical staff will know where their patients are, when and where they are transferred and when they are discharged.
A portal that collects and displays data from underlying systems but also supports clinical workflow, displaying and capturing data at the point of care is what I would define as a 'portal 2.0'. This allows rich clinical data to be analysed to improve clinical practice and provide valuable management information in near real-time.
Raising standards without increasing cost
Recognising that applications that manage clinical data can also provide reliable management information is important. Hospitals can find it very difficult to invest in IT systems on the basis of improving clinical care alone—for an investment to be justifiable, such investment has to improve quality of care and save money. Understanding the benefits of supporting clinical workflow, whilst providing essential management information, makes a compelling business case for IT investment that much easier.
The portal is a loosely defined term, even dated. Up to now, this has resulted in general confusion and missed opportunities to solve the real underlying information issues that remain ever prevalent in healthcare. It is time to redefine the concept of the portal to one that supports clinical workflows and enables more efficient hospital practice.