Advances in Hospital Information System
Copyright 2013 Dr B K Murali
Table of Content
Synopsis
Chapter1-Introduction
Chapter2-Electronic Health Records/Electronic Medical Records
Chapter3- Computerized Practitioner Order Entry (CPOE)
Chapter4- Clinical Decision Support (CDS)
Chapter5- Architecture
Chapter6- Organizational Structure
Chapter7- Interoperability and Standardization
Chapter8- Data Privacy and Security
Chapter9- Application specialist and trainer
Chapter10- System administrator/Database administrator
Chapter11- Hardware and Network Engineers
Chapter12- Security of SaaS
Synopsis
The Healthcare system is a very complex system using multiple information technology systems. Vendors are absorbing different standards for the same systems which in turn shows certain inefficiency leading to errors in the healthcare information. This affects the patient’s medical information and the medical information is also not shared with the healthcare community members. These are some of the stages that motivate to have standardization and exchange of electronic information between the healthcare providers.
Developmental Origins of Health and Diseases (DOHAD) is successful in proving that the individual’s records are very important in explaining the person’s diseases. In order to be meaningful it is very important that each and every medical record should be present since it can be significant depending on the present problems the patient is suffering from.
To be meaningful, there should be detailed health record of an individual. These records can be significant depending upon the patient’s current problems. Thus, it becomes imperative that these records be arranged chronologically to provide a summary of the various clinical events in the lifetime of a person.
EHR is a summary of detailed medical records which are generated during clinical appointment. For maintaining these electronic health records certain standards are very important. To maintain the proper records and information containing clinical codes, images certain standards are compulsory. This report provides the structural overview of EMR standards, clinical standards, EMR/EHR, data privacy and security. The benefits of EMR/EHR are also provided.
This report provides a detailed overview of the EMR standards. The report contains the detailed discussion on adoption of standards, clinical standards, EMR/EHR, data privacy and security. A detailed discussion of EMR and EHR with its benefits is also provided.
Chapter1
Introduction
There are 25 major industries. All 25 of the major industries shamelessly copy technology from the other industries to improve their services, except one. The healthcare industry !
Many hospital owners in India are confronted with a lack of a complete Hospital management system, lack of an electronic medical records system, that they could access from anywhere at any time for their hospitals. They are confronted with a lack of proper tracking system to reduce errors. The challenge is to create a solution to the many issues and challenges faced by hospitals. Remember, India caters to the medical needs of 1.25billion population.
The Solution
Present age Hospital Information System integrates different information systems into one single efficient system. It can be accessed from anywhere anytime from any web enabled device. An ideal HIS solves the problems inherent in a network of multiple programs that are not compatible. It can integrate almost any type of services, systems, departments, processes, data, communication, etc. that exist in a hospital. It can even handle non- medical services or functions like security, maintenance, etc. It is modular and highly scalable. Even if hospital are located in remote areas with poor internet connectivity, works offline and syncs later. It reduces medical errors and improves quality of care.
To study how Indian hospitals were coping without a good HIS, I went from hospital to hospital to see how HAI was monitored. The number of deaths happening in hospitals due to HAI is high. Hospitals do not have tools to analyze data. – if they did analyze, they did nothing! i.e. they were in a in a phase of ‘analysis Paralysis’. Other challenges faced by hospitals were purchasing, running and maintaining large IT infrastructure and resources. Intercommunication is difficult, poor internet connectivity and obsolescence of existing software.
The need was for a unique innovative solution to solve the basic healthcare needs at a cost competitive way in India that we can roll out to other parts of the world as well.
There is an immediate compelling need for a robust HIS
Out of 25,000 hospitals in India only 250 hospitals are accredited by NABH, which means that only 1% of the hospitals in India comply with the government norms to prevent HAI. The hospitals simply do not have the tools or technology as they are not affordable. In 2012, the Indian government enacted the clinical establishment act and made it compulsory for hospitals to comply with certain quality norms. For that hospitals need quality analysis tools. Without these, hospitals cannot get business from Central Government organizations, ex-servicemen associations and many insurance companies. Bottom line- is that they will perish! There is an immediate compelling need to have them now, since the law is being enforced. An application with NABH Quality indicators integrated is an immediate requirement. In India we collect a lot of data but this data is irrelevant if it is not analyzed. An application has the answer to this need whereby we can now provide statistics at a global level and compete with the rest of the advanced countries delivering quality health care. This tool is also necessary for any hospital thinking of Medical Tourism as without NABH accreditation they will not qualify.
In the US market the enforcement of the “meaningful use “incentive has made it a requirement for the health industry to maintain patient electronic medical records, offering practitioners a payment from the Federal govt. to apply this in their day to day activity of improving quality patient care.
Government of India intends to introduce a uniform system for maintenance of Electronic Medical Records / Electronic Health Records (EMR/EHR) by the Hospitals and healthcare providers in the country. An Expert Committee was set up to develop EMR/EHR Standards for adoption /implementation in the country. The Draft Report containing the recommendations of EMR Standards Committee constituted by the Ministry of Health and Family Welfare, Government of India is available in the public domain.
So what are Health Information Systems?
Health information systems are massive integrated systems that are capable of capturing, storing, managing, exchanging or transmitting information related to the health of individuals or the activities of the organizations that work in co-ordination with the health sector. In general, a well-functioning HIS not only helps in improving the individual and public health outcomes by influencing overall sound decision making but also efficiently manages the administrative, financial and legal management.
A good HIS must have the following components .An Electronic Health Records(EHR), Computerized Provider Order Entry (CPOE), Clinical Decision Support Systems (CSS), Laboratory Information System (LIS), Policy and Procedure Management System, Radiology Information System (RIS) or Picture archiving and communication system (PACS), Telehealth and Other Remote Patient Monitoring Technology (Telemedicine), Administrative, Billing, and Financial Systems cater to the several components in an HIS.
Chapter2
Electronic Health Records / Electronic Medical Records
Traditionally, patient records have been paper-based. It’s the recent trend in hospitals that more and mo
re hospitals/health care providers start moving away from paper-based to adoption of an electronic form. They are electronic medical record (EMR) and electronic health record (EHR).
According to the "Integrated Care EHR", as defined in ISO/DTR 20514, an “EMR is a repository of information regarding the health of a subject of care in computer-processable form that is able to be stored and transmitted securely, and is accessible by multiple authorized users”.
It is a logical information model which is autonomous of EHR systems and its main aim is to support efficient health care and it also contains prospective information.
The electronic medical record is a record of medical care provided in a single health care organization, i.e., a record within a single hospital or organization.
An EHR provides information of an individual’s health record for use by health providers across more than one health care organization.
An EMR is a specific recording of electronic medical records, while an EHR is a collection of EMRs and is usually life-long.
Benefits of EMR:
Paperless medical history.
Application system with reduced healthcare costs.
Application provides the doctors ease to deliver right treatment at the right time.
Promote the practice of evidence-based medicine.
Hospital Information System helps in accelerating research and building effective medical practices.
With proper backup policies it increases the lifespan of health records of individuals.
Accessing and using the system is safe and secure.
Benefits of EHR:
EHRs make a patient’s health information available whenever it is needed. EHRs enable clinicians to access the information securely.
EHRs bring the information of patient’s health in a coordinated manner in order to take better health care decisions.
Hospital Information System helps in effective administration of finance, diet of patient, engineering, and distribution of medical aid.
EHRs help the providers to give the patients their prescriptions immediately before the patients leave the providers office.
Chapter3
Computerized Practitioner Order Entry (CPOE)
According to HIMSS, Computerized Practitioner Order Entry or CPOE is “An order entry application specifically designed to assist clinical practitioners in creating and managing medical orders for patient services and medications” (p. 28 HIMSS Dictionary, 2010).
The purpose of CPOE is to automate the patient ordering process. This surely helps in managing patient care more effectively and efficiently which in turn improves patient safety and outcomes.
CPOE’s purpose is to automate the patient ordering process. This in turn helps to manage patient care more effectively and efficiently and as a result, improve patient safety and outcomes
CPOE proves to be a valuable tool and has many advantages when compared with paper-based systems.
·The problem with handwriting identification is addressed.
·The time taken by the order to reach the pharmacy is reduced
·Errors that come with similar drug names are not as likely to occur
·Quite easier to interface with EHRs and decision support systems
Chapter4
Clinical Decision Support (CDS)
CDS provides clinicians or caregivers with clinical knowledge and patient-specific information to help them make decisions that enhance patient care. (Osheroff, J. 2009)
It comes with a knowledge base as for clinical information on diagnoses, drug interaction alerts, and preventive care reminders.
·Clinical decision support could provide suggestions for possible diagnoses that match a patient’s signs and symptoms and communicate this to the provider through a ranked list of diagnoses that might explain the patient’s signs and symptoms.
·It also displays treatment guidelines for specific diagnoses, drug dosage recommendations, or alerts for drug-to-drug interactions.
·It also helps in follow-up management or reminders for drug adverse event monitoring.
·Helps in deciding the length of stay and minimize the stay based on the patient’s outcome.
·Helps to achieve cost reductions and improved patient convenience through duplicate testing alerts and drug formulary guidelines.
Patient Monitoring Devices
This includes the patient monitoring devices that are used in the intensive care unit (ICU) as well as the mobile devices. Devices that are used in the intensive care unit (ICU) help to,
·To get physiological data (Vital parameters) continuously, such as blood pressure readings
·To communicate information from remote locations as for laboratory and radiology departments
·To store, organize data at the same time integrate the data from multiple systems
·To provide clinical alerts and advisories based whenever required
·To evaluate the severity of illness for patient classification purpose
The use of mobile devices in the practice of medical and public health comes under health is also on a rising trend. This refers to using Mobile phones, smart phones, Personal digital assistants (PDA)/palmtop computer or personal data assistant and Wireless tablet computers. This caters to mHealth technologies.
Imaging systems
Imaging systems in healthcare refers to the imaging technologies that capture, store, analyze and display information at the organ, tissue, cellular, and molecular level. It includes use of techniques such as computed tomography (CT), magnetic resonance imaging (MRI), single photon emission coherence tomography (SPECT), ultrasound imaging, interventional radiology, positron emission tomography (PET) and optical coherence tomography (OCT). This area is not limited only to radiology. Other arenas such as cardiology, pathology and gastroenterology also fall under its purview.
Use of Imaging Systems helps in,
·In a quicker diagnosis due to improved access to the studies.
·Decreasing the amount of time taken to provide a report back to an ordering clinician. Images can be retrieved, interpreted and the reporting back to the ordering physician accomplished more quickly.
·Enhancing the image communication. The required images can be viewed by several physicians at different location.
A Picture Archiving and Communication System (PACS) also cater to this component. Digital Imaging and Communications in Medicine (DICOM) a standard used for the electronic exchange of medical images and the data associated with the images here in PACS.
Chapter5
Architecture
The Hospital Information System (HIS) are supported in client-server architectures and the cloud architecture. Software as a service SaaS, sometimes referred to as "on-demand software" supplied by ISVs or "Application-Service-Providers" (ASPs), is a software delivery model in which software and associated data are centrally hosted on the cloud. SaaS is typically accessed by users using a thin client via a web browser. SaaS has become a common delivery model for many business applications, including Office & Messaging software, DBMS software, Management software, CAD software, Development software, Virtualization, accounting, collaboration, customer relationship management (CRM), management information systems (MIS), enterprise resource planning (ERP), invoicing, human resource management (HRM), content management (CM) and service desk management SaaS has been incorporated into the strategy of all leading enterprise software companies. One of the biggest selling points for these companies is the potential to reduce IT support costs by outsourcing hardware and software maintenance and support to the SaaS provider. Cloud applications appeal to providers for a number of reasons. Chief among them are cost, scalability, flexibility, and time to value. More and more providers are adopting a SaaS model for sharing resources and availing the benefits of cost. There is no upfront cost involved in a SaaS application and most SaaS providers charge a monthly subscription.
Many providers fear the loss of security and data privacy
in the cloud. Once they use the cloud, however, they find they are in a more secure and private environment than they were on their own premises, a Microsoft-sponsored survey has found.
HIS can be composed of one or more softwares with several sub-systems in medical specialties, as for example Radiology Information System (RIS) or Picture archiving and communication system (PACS), Laboratory Information System (LIS), Policy and Procedure Management System.
Most work positions for HIS are currently resident types. Mobile computing was the forerunner and now the tablets and smart phone applications are also being used.
Architecture is based on a distributed approach and on the utilization of standard software products complying with the industrial and market standards must be utilized (such as: UNIX operating systems, MS-Windows, local area network based on Ethernet and TCP/IP protocols, relational database
Chapter6
Organizational Structure
Well qualified and experienced individual in computer systems is the head of the HIS department. Today graduate and post graduate candidates with good computer knowledge are available. The HIS department can have the staff members depending on the set up and the use of computerization and its sophistication and as per the requirement.
Organizational structure shows the hospital management levels and these levels allow management of hospital departments to work efficiently. The organizational structure helps one understand the workflow of the hospital. Some organizational structure groups which is common to almost all organizations are Administrative Services, Information system Services, Therapeutic Services, Diagnostic Services, and Support Services. Hospital Information systems if required can also have Database administrator, interface developer.
Chapter7
Interoperability and Standardization
It is very important to understand what exactly Interoperability and standardization is and the role standardization plays to achieve interoperability across different levels of information systems.
So What Is Interoperability?
Interoperability is nothing but the ability of two or more systems or components to exchange information and to use the information that has been exchanged.