What would you call health care software that:

• Is Web-based and networkable, therefore highly scalable and inexpensive to purchase and use;
• Provides a 'unified view' of a patient from multiple sources of data and information;  
• Is designed to be used interactively - by providers and patients alike - to coordinate care and create continuity;
• Offers evidence-based guidance and coaching, personalized by access to a person's health data as it changes;
• Collects, for analysis and reporting, quality and performance measures as the routine by-product of its normal daily use; 
• Aims to provide patients and their providers with a collaborative workflow platform for decision support; and 
• Creates a care plan for each individual and then monitors the progress of each patient and provider in meeting the goals of that plan?

I call this Clinical Groupware. The term captures the basic notion that the primary purpose for using these IT systems is to improve clinical care through communications and coordination involving a team of people, the patient included. And in a manner that fosters accountability in terms of quality and cost.

Clinical Groupware is a departure from the client-server and physician-centric EHR technology of the past 25 years, a fixed database technology that never really became popular.  It is a substantially new and disruptive technology that offers lower price of purchase and use, greater convenience, and is capable of being used by less skilled customers across a broader range of settings than the technology it replaces.



As the name indicates, Clinical Groupware is intended for use by groups of people and not just independent practitioners or individuals. It is not the same thing as an electronic health record, but may share a number of features in common with EHRs, such as e-Prescribing, decision support, and charting of individual visits or encounters, both face-to-face and virtual. Neither is Clinical Groupware bloated with extra features and functions that most providers and patients don't need and, with good reason, don't want to pay for.

Some Clinical Groupware may look and feel like a web-based "EHR lite." But Clinical Groupware aims to create a unified view of the patient, assembling health data and information that may be stored in many different places and in several different organizations - including HealthVault or Google Health -- which most EHRs cannot do.

Clinical Groupware is an evolutionary approach to a shifting health economy in which doing more is not always equated with better care, and the physician or provider role is transforming from autonomous expert to advisor, partner, and guide.   It is also an organic response to the reality that most health care data in electronic format is dispersed across numerous organizations and companies - e.g. hospitals, labs, pharmacies, and devices - and provides a means of accommodating patient demands for a more participatory practice of medicine.

Let me give a couple of examples of this new and emerging class of health software.  RMDNetworks (Denver, CO) and Shared Health (Chattanooga, TN) both offer early examples of Clinical Groupware, although their origins and feature sets are different. RMDNetworks is a privately owned software company that started life as a web portal through which patients and doctors might securely communicate about care. Shared Health is a claims-based health records and quality improvement system for physicians, and is a wholly owned subsidiary of Blue Cross/Blue Shield of Tennessee.

(Full disclosure: I am a member of the Board of Directors of Shared Health, and have been a consultant to RMDNetworks.  Although I could write about this subject using other companies as examples, my insights would be less accurate and well-informed.  I'll leave it to readers to determine my bias level, and react accordingly.  Let me also say that several traditional EHR companies and web portal firms are evolving in the direction of Clinical Groupware, among them eClinicalWorks, RelayHealth, MedFusion, and AthenaHealth.)

Shared Health is a free web-based, highly secure application that offers physicians and medical personnel access to summary health information on their patients who are BCBS of Tennessee members, Medicaid beneficiaries, or employees of several corporations in Tennessee who have signed up to allow their doctors access to their health information. Claims data can be quite rich in detail, consisting of coded diagnoses and problems, medication prescribing and fulfillment information, and lab tests. And this is important: Doctors who use Shared Health's web-app, known as Clinical Xchange, can access information on ALL encounters by a patient with ALL providers, such as emergency room visits or new medications, not just the information in the doctor's own paper charting system or EMR.