W3-EMRS Project

Specific Aims and Signifigance
  1. Implement and distribute low-cost, uniform interfaces to heterogeneous electronic medical record systems (EMRS) on several hardware and software platforms. This effort is highly leveraged by the technological momentum behind the development of the World Wide Web ("Web").
  2. Enable authorized clinicians and clinical researchers to retrieve a patient's history across multiple EMRS and to retrieve aggregate clinical information over defined patient populations. This work is centered on the development of a Common Medical Record.
  3. Apply state-of-the-art cryptographic techniques to protect patient privacy to ensure authorized, selective access to data as well as its secure transmission over unsecured networks.
  4. Demonstrate the general applicability of the technologies we have developed by deploying several demonstration projects to access multiple EMRS currently in operation.

Access to a patient's medical history, including data from all the institutions at which she obtains care, is central to the task of safe and effective care delivery. Yet, the lack of standardization and the proprietary nature of most electronic medical record systems (EMRS) makes accessing data across institutions impossible or difficult and costly. Likewise, many significant clinical research studies have been thwarted by the difficulty of accessing clinical data pertaining to whole populations across multiple EMRS. Further, because most EMRS have failed to take advantage of the latest (often non-proprietary) information technologies, the functionality of these systems has fallen far behind those in comparably sized industries. For example, the use of cryptography to ensure secure transmission of data is common in the banking industry but is hardly used at all to protect patient privacy in modern EMRS.

In 1994, we proposed an architecture (termed W3-EMRS) that enables clinicians and clinical researchers to access the data from multiple existing ("legacy") EMRS using state-of-the-art technologies. The W3-EMRS architecture provides authorized clinicians with access to patient records though a standardized interface accessible from any point through the Internet and from most platforms (e.g. Windows, Macintosh, Unix). A leading motivation in the design of the W3-EMRS architecture was that it should be able to take immediate advantage of any new technologies developed whether or not they were specifically designed for use in medicine. This has enabled us to employ the same cryptographic techniques for communication and authentication used for credit card transactions on the Web without a significant investment on our part.

A retrospective introduction can be found here.

The technical documents of the original project, including the Common Medical Record, are here.

History

In January of 1994, in the course of several conversations between Isaac Kohane and Peter Szolovits two complementary intuitions were elaborated into a project proposal for the development of a internet-based system to access multiple heterogeneous electronic medical record system. The proposal called W3-EMRS was funded by the National Library of Medicine. The first intuition was that rapid development of the World Wide Web (W3) would push the development of pertinent technologies (e.g. platform-independent multimedia documents, cryptographic techniques for secure communication and authentication) that could serve to rapidly advance EMRS functionality and dissemination. The second intuition was that in order to readily provide physicians and patients with consistent functionality across heterogenous EMRS, a Common Medical Record (CMR) abstraction or information model was required. The W3-EMRS project aims to combine the use of Web technologies with the CMR to provide a consistent interface to clinical data to authorized users across the Internet.

In 1995, Isaac Kohane (at Children's, with the help of Jim Fackler) organized the Boston Electronic Medical Record Collaborative with co-investigators from MIT (Peter Szolovits), MGH (Octo Barnett), Beth Israel (Charles Safran). The task domain for the Collaborative was sharing records across multiple institutions for the care of patients in the emergency room. The collaboration, hammered out during multiple breakfasts as the Holiday Inn in Brookline, MA, had several interesting results:

  1. A common data model (called the "Common Medical Record") that expressed enough information for the management of emergency patients.
  2. A working prototype across the three hospitals (Children's Hospital, MGH Laboratory for Computer Science and the Center for Clinical Computing at the Beth Israel Hospital) demonstrating the use of the HL7 messaging standard as the basis for data sharing
  3. A common confidentiality policy and security architecture for sharing records over the web.
  4. Identification of persistent problems in multi-institional data sharing.

In 1997, the grant from the National Library of Medicine expired, and a company, W3Health, was founded to commercialize the W3-EMRS technology. Also that year, John Halamka, at that time a fellow in the Beth Israel's informatics program and also a student in the MIT/Harvard Division of Health Sciences and Technology Informatics masters program implemented a version of W3-EMRS to share data between the East and West campuses of the Beth Israel-Deaconess Medical Center. W3-EMRS has gone on to become the technological underpinning of several other systems.

Publications

1. Hinds A, Greenspun P, Kohane I. WHAM! A forms constructor for medical record access via the world wide web. In: Gardner RM, ed. Symposium on Computer Applications in Medical Care. New Orleans, LA: Hanley & Belfus, Inc, 1995:116-120.

2. Kohane I, Greenspun P, Fackler J, Cimino C, Szolovits P. W3-EMRS: Access to Multi-Institutional Electronic Medical Records via with World Wide Web. In: Hripsak G, ed. Spring Congress of the American Medical Informatics Association. Boston, MA, 1995.

3. Kohane IS, Greenspun P, Fackler J, Cimino C, Szolovits P. Building National Electronic Medical Record Systems via the World Wide Web. Journal of the American Medical Informatics Association 1996;3(3):191-207.

4. Wingerde FJv, Schindler J, Kilbridge P, et al. Using HL7 and the World Wide Web for unifying patient data from remote databases. In: Cimino J, ed. Proceedings, Symposium on Computer Applications in Medical Care. Washington, DC: Hanley & Belfus, Inc., 1996:643-647.

5. Kohane IS, Wingerde FJv, Fackler J, et al. Sharing electronic medical records across multiple heterogeneous and competing institutions. In: Cimino J, ed. Proceedings of the Symposium for Computer Applications in Medical Care. Washington, DC: Hanley & Belfus, Inc., 1996:608-612.

6. Fraser HS, Kohane IS, Long WJ. Using the technology of the world wide web to manage clinical informaton. British Medical Journal 1997;314(7094):1600-1603.

7. Rind DM, Kohane IS, Szolovits P, Safran C, Chueh HC, Barnett GO. Maintaining the Confidentiality of Medical Records Shared over the Internet and World Wide Web. Annals in Internal Medicine 1997;127(2):138-141.

8. Kohane IS, Greenspun P, Fackler J, Szolovits P. Accessing Pediatric Electronic Medical Record Systems via the World Wide Web. Pediatric Research 1995;37:139A.

9. Kohane IS. Exploring the functions of World Wide Web-based electronic medical record systems. MD Computing 1996;13(4):339-346.

10. Wang K, Kohane IS, Bradshaw K, Fackler J. A Real-Time Patient Monitoring System on the World-Wide Web. Proceedings, Symposium on Computer Applications in Medical Care. Washington, DC: Hanley & Belfus, 1996:729-732.

11. Wang K, van Wingerde FJ, Bradshaw K, Szolovits P, Kohane I. A Java-based multi-institutional medical information retrieval system. Proc AMIA Annu Fall Symp 1997:538-42.

Personnel

For more information contact kohane@a1.tch.harvard.edu