Therefore, they seem to have evolved an attitude that because medicine is unique, technology for medical systems must be unique as well. In fact, early systems did exhibit advanced features that were well ahead of commercial data processing systems of their time. This legacy led, however, to a tradition of continued independent development, in which medical system developers did not share in the adoption by almost all others of technologies such as relational data base systems, networking, open sytem interfaces, client-server computing, a degree of platform independence, and access and communication security. By late 1994, with Philip Greenspun, an MIT graduate student, we had been able to build a simple prototype system, called MedWeb, that does in fact allow access to a small subset of actual records from Children's via the Web. I will show the capabilities of our prototype system in my presentation.
Security provides an interesting and central illustration of the potential value of our approach.
In the decade since the Children's system was designed and built, access to data from outside the institution has become a critical concern. Not only do doctors now expect to be able to call in from their home or office computers via phone lines and get access to the latest clinical data, but even traditional outsiders such as the referring doctor are seeking rapid access to data, notes, and care plans. Today, Children's supports outlying clinics that require full access and would like, as part of its attempt to appeal to more referring doctors, to support direct access by them to the records of their own patients, while hospitalized. In a custom-built system, such security is expensive, needs to be individually grafted on, and may not provide adequate protection. The current system, for example, uses sophisticated means of assuring that only those off-site people who can authenticate themselves have access.