Healthcare is an information-rich environment, and while information systems help manage the deluge of data, the technology is still highly dependent upon labor-intensive processes. For each patient encounter, consider the staffing resources that are consumed to input, locate, access, distribute, analyze and store information. A vast amount of information is stored in multiple systems, but the intelligence of how to handle this information — getting the right information into the right hands at the right time — largely resides within the heads of the staffing resources that use the systems.

In essence, these staffing resources act as information brokers — they know where and how to access data, and they apply their intelligence to the handling of it. However, these staffing resources come at a high cost, in terms of salary, benefits and training. Furthermore, the efficiency of this staff-based intelligence is likely to reach a point of diminishing return when it is applied on a large scale, such as in a health information exchange (HIE) or a regional health information organization (RHIO). A new generation of technology is being used to replicate this information handling intelligence into software agents — small, autonomous applications that can be deployed wherever needed to handle specific tasks without human intervention, such as collecting and distributing data.

Agents — Managers of Information

Agents work with existing applications — enhancing their capabilities rather than competing with them — to seek out, capture, distribute and even translate the format of data when necessary. Agents replicate the intelligence needed to accomplish specific tasks, while making that intelligence portable so that it can be reused and applied in other situations. This next generation of technology is quickly becoming an important tool for healthcare organizations to reduce costs and improve the flow of information. Although they may not be aware of it, people frequently use software agents embedded in search engines to scour the Web for information.

The user doesn’t have to tell the agent where to look for the information because those instructions are already programmed into the agent. Personalized news readers, such as the ones offered by Yahoo!, Google and others, use agents to search the Web for news stories that contain the types of information requested by the user. Even most e-mail systems use agents to search for mail, pull it off servers, and send it back to users to read — all done without requiring the user to know POP3 protocols, since that intelligence is already a part of the agent’s configuration.

Agents perform work on behalf of their users, filling the role of a personal assistant employed to manage specific tasks. In addition to performing tasks for people, agents can also perform tasks for other applications and even other agents. For example, an application may request an agent to monitor the operating parameters of equipment and report back to the application if there are problems. Or, an agent can be configured to process information in a specific way once it receives data from another agent. Agents can exchange information over a secure information grid, which allows them to work behind firewalls to collaborate and synchronize information based on common interests.

A Cost-effective Combination

Grid computing enables computers to leverage the Internet to share resources, such as computing power, data storage and information. Once configured, agents require minimal IT resources to maintain. Agents and grid technology have several characteristics that differentiate them from interface engines, Web portals and file sharing programs. Rather than centralizing data, agents acquire and distribute information to where it is needed based on user preference. This increases security, as the agents only deliver information to authorized users, instead of relying on remote users to “pull” data off a system. In addition, agents have the capability to learn over time through associations, rules and behaviors.

The combination of agents and grid technology create a solution to facilitate healthcare data exchange between applications, and serve as a bridge to future standards. For healthcare organizations, agents provide the opportunity to reduce the reliance on staffing resources and increase the value of other hospital information systems (HIS). Consider, for example, the various types of information that are frequently gathered during a patient visit. Laboratory reports might be received via fax, but may also be accessed online via the reference lab’s portal.

Radiology reports are in one system, while digital images are in another, and film is stored somewhere else. Patient records may be within an electronic medical records system (EMR), on a shelf in a folder, or even within a physician’s briefcase. Agents can be configured to locate and access this type of information within a single facility or between multiple sites throughout a community. For example, agents interfaced to an HIS can distribute information over the grid to agents in physician offices, regional databases and other locations.

Agents offer healthcare organizations a cost-effective approach to increasing revenue through lab outreach services, and their flexibility enables their use regardless of existing infrastructure. Since they are small, autonomous applications, agents can run on existing servers to tap into unused computing resources. They also have the ability to transform data into different formats, such as mapping proprietary formats to standards-based formats (e.g., HL7, PDF, XML, text and others), allowing users to receive information in the correct format.

Deploying agents and grid technology typically costs a fraction of what it takes to expand existing information systems to gain similar functionality. Beyond these savings, other financial benefits include the potential for revenue increases resulting from new lab outreach services, and reduced staffing costs due to automated information collection and distribution. From an operations standpoint, agents streamline workflows, reduce staffing workloads and eliminate time spent retrieving information. In facilities that are primarily paper based, using agents can alleviate many of the burdens associated with managing equipment such as printers and fax machines used for producing and distributing materials.

Improving Information Quality

The use of agents has a minimal impact on the IT department, since the technology can piggyback on existing servers and information exchange can take place over the networks that are currently installed. Agents can be centrally managed, and once configured, they are basically maintenance free. Because agents work in the background without human intervention, training staff to use agents is not necessary. Most importantly, the use of agents improves the quality of the information that clinicians receive. By reducing the time that is spent managing information, clinicians can focus their attention on using information to improve patient care and outcomes.

Spectrum Health, a not-for-profit health system in west Michigan with seven hospitals, is deploying agents and the grid network to resolve separate business challenges. First, Spectrum Health was competing for outreach revenue among its provider network with reference labs that had the capability to deliver results directly into the practice’s EMR solutions. Rather than acquiring a new point solution, or expanding the capabilities of its laboratory information system and network infrastructure, Spectrum Health turned to agents and a grid network to electronically collect orders and deliver lab results to its physicians.

The second challenge arose with Spectrum Health’s strategic initiative to create a world-class cancer research and treatment center with the construction of its 280,000-square foot Lemmen-Holton Cancer Pavilion. Spectrum Health’s goal of integrating various cancer specialists to provide a singular patient experience under one roof created the technological challenge of information sharing among multiple systems. The use of agents and grid network technologies is expected to provide Spectrum Health with a cost-effective way to exchange data among the numerous solutions used by various specialties, such as infusion therapists, radiation oncologists and others.

This next generation of technology is quickly becoming an important tool for healthcare organizations to reduce costs and improve the flow of information.

Why Healthcare Needs Agents

The result will be an agent-based patient record that maintains real-time patient information, enabling clinician access to actionable information about all current treatments. Agent and grid networks appealed to Spectrum Health because the non-disruptive technology provided solutions to both tactical and strategic business challenges. Like Spectrum Health, more than 250 hospitals and hundreds of physician practices throughout the country are deploying agents and grid networks to resolve their business challenges. The flexibility and low cost of agent and grid networks makes them a technology worth considering regardless of organization size, type or location.

Today’s healthcare enterprises are striving to improve the quality of care delivery through improvements in the exchange of information, whether it’s for multifacility systems, community wide initiatives or larger RHIO efforts. Regardless of the project’s scope, the use of agents provides organizations with the opportunity to increase the value of their existing technology investments while reducing staffing workloads and costs.