Submitted by:
Sean McLinden, MD
/Chairman, Health
Information Sciences
Duquesne University
325 Rangos Hall
Pittsburgh, PA 15282-0001 USA
Categories:
Health care/health services
Keywords:
Innovative or improved ways of doing things; More equitable access to technology or electronic information; Creation of new ideas, products, or services; Local commitment to network-based activities; Volunteer contributions of time and energy
Supporting Documentation (contact author for more information):
Video; Software; Documentation; Slides/photographs; Computer graphic images, such as GlF files Other (live presentations)
The Story:
Internet Applications to Health Care Quality and Efficiency The FELIX Tool for Business Re-engineering
Business process re-engineering, an approach widely regarded as the key to revitalizing businesses in the United States has yet to hit the health care industry. Key among the many reasons why this is true is the nature of hospitals, which (like many manufacturing conglomerates), were built from a collection of indepdendent (and sometimes competing) clinical specialists. Frequently, these independent (yet, necessarily interdependent) entities result in duplicity of process and collision of information which interferes with the quality and efficiency of the care of the patient. Why has this obvious problem not been addressed?
Many reasons exist but primary among them is the nature of health care services and the medical marketplace. Community medical services are structured, not according to the needs of the community, but according to the availability of resources. If economy, geography, climate and culture make it desirable for cardiothoracic surgeons to move into the area, the services offered will be oriented toward cardiothoracic surgery. Health care in many communities is determined by specialty make up of the health care practitioners, not by the needs of the community.
Health care “reform” has been an unfortunate way to characterize what is really a “re-invention of the health care process. This re-design involves the shift from practice-oriented clinical practice to community-oriented health care, which is a new model in many parts of the United States. The urgency of such a paradigm shift has been enhance by proposed health care legislation from both the President and the Congress. In spite of the need to embrace new models of health care delivery, many healthcare organizations continue to operate in an information infrastructure which is incapable of managing the necessary changes to produce a lean organization tuned to health care at the community level. Key to the management of patients, in any context, is the management of information flows and processes which characterize the patient care environment.
FELIX was born out of this environment of chaos and change. Designed by a team of clinicians, administrators, information scientists, and industrial engineers, FELIX evolved from its roots as a patient management system into a tool to promote controlled organizational change.
What is FELIX?
FELIX is multimedia information authoring and management tool designed to facilitate the sharing of complex patient and process information across networks. Using the X windowing system, a high- level application scripting language, and standards for networked information interchange, FELIX provides an electronic bridge to sources of information distributed over many sites on a network. Unlike typical network browsers and wide area information systems, FELIX allows the user to integrate these sources into a single, coherent, framework for presentation and manipulation based on the concept of a virtual structured document.
FELIX is not just a technology. Instead, it is the articulation of many real- world social constructs into an electronic representation that allows the user to visualize the relationships between information and information sources. Through FELIX, the user can discover not only information, but also the process by which this information was created. This facilitates organizational self-discovery, one of the first steps toward empowering users to contribute meaningful changes to the organization.
Implementation of FELIX was begun following frustrated attempts to begin business process re-engineering using discussion groups and the Delphi method. It was found, by the FELIX developers, that while most members of the clinical community were open to change and learning, organizations provided little incentive for them to undertake this arduous process.
FELIX is the carrot and the stick to just such organizations. By providing interactive graphical metaphors coupled to standard business applications such as calendar management and scheduling, electronic mail and messaging, and document creation and management, we were able to enlist the support of the organization in a process which was, otherwise, regarded as tedious and of a low priority.
FELIX started as a multimedia clinical information system but much to our surprise we found that it was also a powerful agent of organizational change.
FELIX was influenced by many practical demonstrations of social computing, including the Andrew system at Carnegie Mellon University, the World Wide Web, WAIS, and the University of Minnesota Gopher, USENET news and the Multipart Internet Mail Extensions (MIME), Cornell Cello and NCSA Mosaic.
The FELIX user interface was based on work done at the Software Engineering Institute (CMU Serpent), the University of California at Berkeley (TCL), Brown University (FIELD and Intermedia), the University of New Mexico (KHOROS), and Stanford University (Interviews). The information browser combines visual programming metaphors (ala KHOROS and NeXTStep) with a semantic network which describes the organizations functional areas, processes, and the interconnectedness of these to the outside world.
FELIX is designed to be affordable. A fully operating FELIX workstation can be purchased for approximately $5000.
FELIX is based on industry standards for data representation including X, TCP/IP, SGML, SQL and SQL-II, and PostScript. No proprietary data formats are required or supported by the FELIX architecture.
FELIX is based on widely available and off-the shelf industry platforms. FELIX has been tested on HP 9000/700s running HP-UX 9.0, Sun Sparc 2 running Solaris 2.0, Apple Macintosh Ilci and Quadras running A/UX 3.0 and System 7.0.1 with GatorX, and Univel UnixWare on 486s.
FELIX is designed for network operation using the Internet as a model for global networking. FELIX is scalable, so that the same metaphors can be used in a system at home or in the private office as in the large hospital. Problem tracking and trouble shooting in FELIX is accomplished by advanced messaging services between the client user and a system architect connected via the Internet.
The FELIX architecture has been designed to anticipate practical advances in global telecommunications including SMDS and broadband ISDN.
Who developed FELIX?
FELIX was developed in an academic urban referral hospital by a team of people described in the introductory paragraphs. Although it is a system still in development, FELIX is not an experimental architecture or a model. It was designed to manage real patient care processes and real clinical process information.
Who owns FELIX?
FELIX is owned by GFN Software Consortium, a partnership of clinicians, information managers, industrial engineers, and consumers of health care. GFN is a unique organization dedicated to the development of a single software product, FELIX, which will be made freely available to interested members of the health care community for institutional or personal use or non-commercial re distribution. As the mission statement for GFN states, categorically, that the purpose of the consortium is the development of non-commercial software, users need never worry that a subsequent version or upgrade will need to be purchased.
How is FELIX development supported?
FELIX development continues through the contributions of the user community, funding through consortium members, or contract work done by GFN to develop specific extensions to FELIX. In all cases, the development is incorporated into subsequent releases of FELIX for use by the entire user community. FELIX is also used as the basis for an innovative graduate and continuing education program for clinicians at the Department of Health Information Management, Duquesne University (Pittsburgh) where graduate students continue to work on its development. >
GFN and Duquesne University also support FELIX development by providing consulting services to health care organizations attempting business process re-engineering or the development of computer-based medical records. Consulting services offered by this partnership are intended only for those institutions and clinical practices committed to reform of the health care system through cultural development which promotes a lean organization supporting the highest quality patient care processes at the best possible price.
What is the status of FELIX, how do I find out more?
There is a FELIX mail box: felix@dsl.pitt.edu. Interested parties should send their name, surface mail address, and phone number to that box. Surface mail should be sent to Sean McLinden, MD, Chairman, Health Information Sciences, Duquesne University, 325 Rangos Hall, Pittsburgh, Pennsylvania, 15282-0001. A description is also available via WWW or ftp. > FELIX is still in development mode. We expect to be able to announce something of a release schedule within the next few months. This will depend up the rate of progress on key parts of the FELIX architecture.
FELIX, in its first release, will not be an end-user system, per se. This is because few if any current health care vendors actually support industry standard architectures for network data sharing and none support any concept of an industry standard data dictionary. The first release of FELIX will be intended to provide organizations with a target architecture around which they might build PFPs for future information systems and by which they might plan for a more robust information infrastructure in the future.
As the health care marketplace becomes more sophisticated about their health care information systems purchases, we expect that FELIX will easily integrate into their information architectures.
What is GFNs mission statement?
The mission of GFN is to make it possible for the health care community to address the most pressing needs of our population in a manner which promotes the highest quality at the best possible price. To make this possible, we are developing a software tool, FELIX, to promote continuous quality improvement by facilitating the processes of patient management and health care admininstration. FELIX, our sole product, will always be freely available to any institution or individual whose goal it is to provide health care according to the terms of our mission.
We do not believe that health care reform will come from the government though external economic measures but from within the organizations and communities that are directly responsible to the patients. This reform, true reform, should be motivated, not by the desire to escape economic doom, but by an professional culture which recognizes the special privilege which we enjoy as the caretakers of the nation’s health.
This “reform from within” should come about whether or not extrinsic factors exist to provoke. The crisis we are facing is not an economic crisis although it has economic implications. It is a crisis in process management that has come about through a crisis in information management resulting from the failure of our past paradigms to address the health care needs of our population.
GFN is committed to one goal, alone. Improving the quality of patient care by improving the behaviors which lead to inefficient or misdirected patient care processes.