A ``Clinical Portal'' Is Born

Oslo's new homegrown system is in demand around the globe

After seven years of planning, thousands of man-hours of programming, and tens of millions of dollars spent on new computers and networks, it all came down to one night. In the final minutes of Mar. 14, engineers at Oslo's Rikshospitalet Universitetsklinikk, a top European research hospital, flipped the switch on an ambitious new information system that should eliminate virtually every scrap of paper used there by 2007.

At the stroke of midnight, patient charts, lab results, X-rays -- some 70% of the hospital's paperwork -- went electronic. ``I've been waiting a long time for this,'' says Glenn Kenneth Bruun, the hospital's 33-year-old information technology director, who spearheaded the project. When the changeover is complete, Bruun figures it could save Rikshospitalet up to $66 million a year in costs, not a bad improvement on a $925 million annual budget. More important, once all records are digitized, the hospital will be able to do things never possible before -- compare productivity in different departments, examine workflows to streamline operations, even mine anonymous patient records for hidden health-care patterns.

Rikshospitalet is far from alone. The European Union has an e-health initiative to digitize patient data and put it online by the end of this year, in part to contain spiraling health spending, which grew 52% faster than Europe's economy in the 1990s. But the Oslo hospital's homegrown technology is among the most advanced in the world. Developed over the past few years by a team of 25 contract programmers, it uses Internet technology to create a ``clinical portal'' that links 1,300 disparate applications employed throughout the hospital. That lets Rikshospitalet preserve its investment in existing software and permits doctors to keep using familiar tools, while wrapping the whole shebang in a new, easy-to-use Web interface. The portal, dubbed Clinical Systems All Managed (CSAM), also provides secure access for patients who want to examine their own medical data over the Net.

In an era of rising costs and tightening budgets, that approach wins plaudits. ``You just can't rip everything out and replace it with a shiny new system,'' says Jonathan Edwards, a research director with Gartner Inc. who tracks health-care info tech in Europe. Indeed, Rikshospitalet's scheme to integrate existing applications is so appealing that the hospital has spun out a private company, CSAM International, to sell the software around the world. The startup is in talks with medical centers in China, Japan, Thailand, and Bosnia. And in conjunction with French IT-services company Atos Origin, it's a finalist for a $4 million job to outfit four hospitals in the Västmanland region northwest of Stockholm. ``Portals are easy to design on paper but very difficult to implement well,'' says Knut Korsell, Atos Origin's Nordic business development manager. ``We offer a system that already works.''


Credit that to painstaking programming by the Rikshospitalet crew. ``The only way to do this is from the inside out,'' Bruun says. His developers spent years querying doctors on their needs and testing prototypes in real-world settings. Occasionally they ruffled a few feathers: Bruun recalls that some doctors were offended when he demonstrated that the new software could track which departments were late filling out forms. Such ``cultural change,'' he says, is essential for hospitals to become more efficient.

The long-term benefit of Rikshospitalet's new portal will be to shift the focus of medical IT from automating operations to boosting information flow. The hospital's doctors, which include world-renowned surgeon Dr. Erik Fosse, will be able to collaborate more easily with colleagues around the globe, and patients will gain greater control over their care by monitoring it online.

That's a goal shared by everyone in the profession. ``Technology doesn't matter,'' concludes Gartner's Edwards. ``It's all about how you use it to change the way you work.'' The Norwegians are off to a fast start in doing just that.

By Andy Reinhardt in Oslo

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