Chapter 7: Hospital Information Systems

Presented by Dan Sheldon

• Operational Requirements
  • up-to-date factual information
  • necessary for day to day tasks
• Planning requirements
  • short- and long-term decisions about patient care
  • decisions about hospital management
• Documentation Requirements
  • the maintenance of records
  • accreditation
  • legal record

It costs a lot of money to deal with the information in a hospital.

The Friedman and Martin functional model for an HIS:

• Core Systems
  • patient scheduling
  • admission
  • discharge
  • admission-discharge-transfer (ADT)
• Business and Financial Systems
  • payroll
  • accounts receivable
• Communications and Networking Systems
  • integration of all parts of the HIS
  • order entry & results reporting
• Departmental-Management Systems
  • the needs of individual departments can be met
  • those subsystems can be useful in a macro-system
• Medical-Documentation Systems
  • collecting, organizing, storing, and presenting
  • Quality Assurance (QA)
• Medical Support Systems
  • assistance in interpreting data
  • issue alerts, provide advice

It can be useful to integrate the clinical and the administrative information into the same information system. This can create a "rich database for decision making."

Alternative Architectures for Hospital Information Systems:

• Central Systems
  • total or holistic system
  • one main computer handling all the information
  • many terminals and printers for information exchange
  • TMIS
  • Problems:
    • very difficult to backup
    • hard to keep up to date technology
    • all or nothing effect
• Modular Systems
  • distinct software modules carry out specific tasks
  • "plugging in" new task performance
  • HELP
  • Problems:
    • "plugging in" never works very well
• Distributed Systems
  • LAN structure
  • independent computers tailored for specific uses
  • autonomous
  • computers with shared data
  • can connect multiple LANs
  • PROMIS

Comparison:

• Technicon Medical Information System (TMIS)
  • among the oldest (started in 1965)
  • developed between Lockheed and El Camino Hospital
  • only accomplished Information Management
• HELP System
  • developed at the LDS Hospital
  • provided information management, physician guidance, and clinical-research support
  • physician guidance was accomplished through "knowledge frames"
    • set alarms
    • warning if "this is true" then "do this"
• PROMIS (Problem-Oriented Medical Information System)
  • developed at the Medical Center Hospital of Vermont and the University of Vermont
  • designed to completely replace paper
  • used by the physician during a session to guide his/her analysis
  • severely constrictive and not well received
  • made an impact upon later HISs

Trends in HIS development:

• Local-area communication networks
  • LANs are cheaper and more effective
• Workstations and personal computers
  • On a LAN you need some computers
• Bedside terminals
  • Have not caught on yet due to cost
• Linkages between hospitals and physicians
  • as automation occurs natural links occur