Hospital Information Systems

Definition: Integrated, computer-assisted systems designed to store, manipulate, and retrieve information concerned with the administrative and clinical aspects of providing medical services within the hospital.

hospital information system

Informatics The computer hardware and software that processes a hospital's data, including financial, Pt-related, and 'strategic' management data, Pt accounts, Pt tracking, payroll, reimbursements, taxes, statistics

Hospital Information System (HIS)

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A comprehensive information system dealing with all aspects of information processing in a hospital. It is an integrated, computer-assisted system designed to store, manipulate and retrieve information concerned with the administrative and clinical aspects of providing services within the hospital. A hospital information system encompasses human (and paper-based) information processing as well as data processing machines. Traditionally used to describe hospital computer systems with functions like patient admission and discharge, order entry for laboratory tests or medications, and billing functions.

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HIS (Hospital Information System Or Healthcare Information System)

The IT applications used to manage hospital operations (e.g., patient financials, registration, scheduling, general financials, back-office systems and order communications).

Hospital information system

From Wikipedia, the free encyclopedia

There are several titles and acronyms for similar approaches to managing the flow and storage of information in hospital routine services. These include:

Hospital Information System (HIS) Healthcare Information System Clinical Information System (CIS) Patient Data Management System (PDMS)

These are comprehensive, integrated information systems designed to manage the medical, administrative, financial and legal aspects of a hospital and its service processing. Traditional approaches encompass paper-based information processing as well as resident work position and mobile data acquisition and presentation.
Contents 1 Architecture 2 Aim 3 Standardization 4 Benefits of HIS

Architecture
Generally all types of hospital information system (HIS) are supported in client-server architectures for networking and processing. Most work positions for HIS currently are resident types. Mobile computing began with wheeled PC stands, and now tablet and smartphoneapplications are used. Enterprise HIS with Internet architectures have been successfully deployed in Public Healthcare Territories and have been widely adopted by further entities.[1]

A cloud computing alternative is not recommended, as data security of individual patient records services are not well accepted by the public. HIS can be composed of one or several software components with specialty-specific extensions, as well as of a large variety of sub-systems in medical specialties, for example Laboratory Information System (LIS), Policy and Procedure Management System,[6]Radiology Information System (RIS) or Picture archiving and communication system (PACS). CISs are sometimes separated from HISs in that one focuses the flow management and clinical-state-related data and the other focuses the patient-related data with the doctor's letters and the electronic patient record. However, the naming differences are not standardised between suppliers.

Aim
As an area of medical informatics the aim of an HIS is to achieve the best possible support of patient care and outcome and administration by presenting data where needed and acquiring data when generated with networked electronic data processing. Organizational Structure The head of the HIS department is a person who is qualified and experienced in computer systems. Graduate and postgraduate computer diploma/degree holders are available. Depending on the set-up and the extent of computerization and its sophistication, the department may have some or all of the following staff in addition to the head of the department. Systems Administrator/Database Administrator The systems administrator-cum-database administrator is responsible for systems administration to ensure high uptime of the system and for handling all database back-up and restoration activities. Application Specialist and Trainer The hospitals application specialist together with the software vendor is involved in all the activities required for implementing the application software. Trainers train and retrain new employees in the hospital. Hardware/network Engineers Hardware/Network engineers are responsible for maintaining the hardware and network systems in the hospital. They undertake all troubleshooting activities that may be required to keep the system online and patient data available to doctors and nurses.

Standardization
There is no standardization but for data formats and for data interchange, as with the HL7 initiative supported by ISO.

Benefits of HIS
Easy access to doctors data to generate varied records, including classification based on demographic, gender, age, and so on. It is especially beneficial at ambulatory (out-patient) point, hence enhancing continuity of care. As well as, Internet-based access improves the ability to remotely access such data.[7] It helps as a decision support system for the hospital authorities for developing comprehensive health care policies.[8] Efficient and accurate administration of finance, diet of patient, engineering, and distribution of medical aid. It helps to view a broad picture of hospital growth Improved monitoring of drug usage, and study of effectiveness. This leads to the reduction of adverse drug interactions while promoting more appropriate pharmaceutical utilization. Enhances information integrity, reduces transcription errors, and reduces duplication of information entries.

Chapter 7: Hospital Information Systems

Presented by Dan Sheldon The purpose of a hospital information system (HIS) is to manage the information that health professionals need to perform their jobs effectively and efficiently. Information Requirements:

Operational Requirements o up-to-date factual information o necessary for day to day tasks Planning requirements o short- and long-term decisions about patient care o decisions about hospital management Documentation Requirements o the maintenance of records o accreditation o 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 o patient scheduling o admission o discharge o admission-discharge-transfer (ADT) Business and Financial Systems o payroll o accounts receivable Communications and Networking Systems o integration of all parts of the HIS o order entry & results reporting Departmental-Management Systems o the needs of individual departments can be met o those subsystems can be useful in a macro-system Medical-Documentation Systems o collecting, organizing, storing, and presenting o Quality Assurance (QA) Medical Support Systems o assistance in interpreting data o 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 o total or holistic system o one main computer handling all the information o many terminals and printers for information exchange o TMIS

Problems: very difficult to backup hard to keep up to date technology all or nothing effect

Modular Systems o distinct software modules carry out specific tasks o "plugging in" new task performance o HELP o Problems: "plugging in" never works very well Distributed Systems o LAN structure o independent computers tailored for specific uses o autonomous o computers with shared data o can connect multiple LANs o PROMIS

Comparison:

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

Trends in HIS development:

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

Hospital Information System Project (HISP)

The Hospital Information System Project (HISP) is a province-wide initiative designed to improve access to patient information through a central electronic information system, an electronic patient record (EPR). HISPs goal is to streamline patient information flow and its accessibility for doctors and other health care providers. These changes in service will improve patient care quality and patient safety over time. The first site for the introduction of the EPR in Winnipeg is St. Boniface General Hospital (SBGH).

System Components
There are five key components or modules in the system.

1. 2.

3. 4. 5.

Registration The system captures and records patient demographics and visits at the point-of-care. Registration data will be displayed consistently and automatically on screens in the clinical system. Order Entry and Results Reporting All clinical orders will be listed with indications of what has been completed and what is pending. Electronic alerts will appear for orders duplication and errors and provide information to assist clinical decision-making. All test results in the patients electronic chart will be filed with alerts for abnormal results. Clinical Documentation This module provides on-line documentation of clinical encounters such as flowcharts and structured notes. Eventually this information will be shared across health care facilities within Manitoba. Scheduling Patient scheduling schedules patients for appointments with clinicians or for tests and procedures. Patient Billing All billable health services will be accessible and processed in this system. Examples: private rooms, out-of-country coverage. The vendors selected to provide the software is Eclipsys. The Eclipsys suite of clinical software is known as Sunrise Clinical Manager (SCM), Sunrise Access Manager (SM). MediAR is the software for the billing system.

Who Benefits
Physicians

Nurses

Introduces Computerized Provider Order Entry (CPOE) Improves accuracy & legibility of, and access to, the required patient medications Improves clinicians efficiency & effectiveness through provision of key patient information (e.g., allergies) at time of ordering, plus conflict checking, order checking and online access to best practice information Improves care through the logging of all orders Reduces medication error rates

Will Will Will Will

allow immediate access to orders and results provide immediate access to patient demographics, medication and test results provide improved access to information on line (ie: suggested medications or drug alerts) decrease the need for paper, decrease errors and increase patient safety

Allied Health Professionals

Will Will Will Will

allow immediate access to orders and results provide immediate access to patient demographics, medication and test results provide improved access to information on line (ie: suggested medications or drug alerts) decrease the need for paper, decrease errors and increase patient safety

Ward and Registration Clerks

Will provide a single point of contact for patient registration information and reduce duplication of effort

Clinical Benefits

Provide a common source of information about a persons health history Enhance the ability of health care professionals to coordinate care by providing a persons health information and visit history at the place and time that it is needed Link information from diagnostic information systems such as X-ray and laboratory into the EPR Strengthen internal and external communication among health care providers Eventually be accessible for use in all of Manitobas academic and community hospitals, as well as long term care facilities Allow care providers access to the patients health history and results between facilities Will provide improved access to information on line (ie: suggested medications or drug alerts) Will decrease the need for paper, decrease errors and increase patient safety

Administrative Benefits

Will provide improved access to information on line (i.e. suggested medications or drug alerts) Will decrease the need for paper, decrease errors and increase patient safety Strengthen internal and external communication among health care providers Will decrease the need for re-registrations of patients across multiple sites

Major Milestones / Schedule

Phase I - Went live April, 2007 at St. Boniface General Hospital (SBGH), which included Registration Electronic Patient Record (EPR), Billing and Results Viewing. Phase IIa - SBGH is now officially live with Computerized Provider Order Entry (CPOE) and Medication Worklist. The completion of electronic order entry occurred in mid-February, 2009. Phase IIb - Clinical Documentation (Implementation schedule under review)

Glossary
Computer Provider Order Entry (CPOE) - Systems perform checks in the background when providers write orders. These checks include whether the patient is allergic to the drug, whether there are interactions with other drugs the patient is taking, whether the dosage ceiling for the drug is being exceeded, and so forth. When orders are entered that are contraindicated for the patient, alerts and reminders pop up. These give the provider options to change the order or document a reason for overriding the alert.

Health Management Information Systems

Why health information system?

Good management is a prerequisite for increasing the efficiency of health services. Improved health information system is clearly linked to good management.

Information is crucial at all management levels of the health services from periphery to the centre. It is required by policymakers, managers, health care providers, community health workers. Changing the way information is gathered, processed, and used for decision-making implies changing the way an organization operates. Definitions System - Any collection of components that work together to achieve a common objective. Health System - All the activities whose primary purpose is to promote, restore or maintain health. Information - Meaningful collection of facts or data. Information System - Systems that provide specific information support to the decision-making process at each level of an organization. Health Information System - A set of components and procedures organized with the objective of generating information which will improve health care management decisions at all levels of the health system. The ultimate objective of health information system is not to gain information but to improve action What is wrong with current health MIS?

Irrelevance of the information gathered

Poor quality of data Duplication and waste among parallel health information system Lack of timely reporting and feedback Poor use of information

The difference in culture between data people and decision makers: Planning and management staff rely primarily on gut feeling to formulate ad hoc decisions rather seek pertinent data.

First level (dispensaries) To provide curative care for the most common health problems To provide prenatal care services To organize under-5 clinics (including immunization) To provide family planning services To provide IEC services in the catchment area Secondary level (First referral level) To organize out-patient referral clinics To provide in-patient services To manage medical, surgical & gynecological emergencies To provide X-ray and laboratory facilities Tertiary level To provide all types of surgical interventions To provide specialized care

Management functions in a health service system The central level (Ministry of Health) is responsible for: Health policy formulation, including policy on intersectoral activities Production of national health plans and guidelines for local planning Advisory role on allocation of resources, particularly capital funds Source of high level technical advice for specific programmes Training and regulation of health personal development Regulation of private profit and nonprofit health organization Control of national health organizations and research institutes Liaison with international health organizations and aid agencies State level is responsible for: State health planning and programme monitoring Co-ordination of all regional health activities Employment and control of the health personnel

Budgeting and Auditing the health expenditure Managerial and technical supervision of district health teams Provision of supplies and other logistical support

Steps involved in restructuring of Health MIS Step 1: Identifying information needs and feasible indicators Step 2: Defining data sources and developing data collection instruments for each of the indicators selected Step 3: Developing a data transmission and processing system Step 4: Ensuring use of the information generated Step 5: Planning for health MIS resources Step 6: Developing a set of organizational rules for health information system management Step 1: Identifying information needs and feasible indicators

Identifying information needs for follow-up of a pregnant woman in a primary level Identifying indicators to ensure efficient drug management in a referral hospital Identifying indicators to ensure efficient Information, Education and Communication in the community

Identifying indicators to monitor the quality of supervision by the district management team Step 2: Defining data sources and developing data collection instruments for each of the indicators selected Develop an appropriate record form for follow-up of haemo-dialysis in a tertiary care hospital Develop a monthly reporting form for activities performed in a primary level clinic Define data sources for a situational analysis at the district level Develop data sources for monitoring the quality of teaching in a medical college

Step 3: Developing a data transmission and processing system Structure the information flow on pregnant women between the traditional birth attendant and midwife in the health centre Ensure that monthly report forms from health centres are entered in the district computer in a timely and accurate manner Develop a mechanism for reporting of Research done in a research centre Step 4: Ensuring use of the information generated Develop user-friendly feedback formats for regional mangers on the utilization of inpatient services in the region Train health auxiliaries in follow-up procedures for hypertension patients using a standard record form Develop a curriculum for the undergraduate and post-graduate students depending upon the need in the

country

Ensure research on the priority health issues for the country Step 5: Planning for health MIS resources Create positions of computer operators in cases where district level data processing is computerized Submit revised recurrent cost budgets based on proposed new data collection procedures

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Ways to enhance the use of information in decision-making

Characteristics of the data Characteristics of the problems and the decisions they require Organizational or structural characteristics Cultural differences between data people and action people

The communication between the two Characteristics of the data Ownership and relevance Validity and reliability Aggregation of data Customizing information to the users needs Timeliness of feedback

Characteristics of the data

Ownership and relevance Validity and reliability Aggregation of data Customizing information to the users needs Timeliness of feedback

Different characteristics of the users (action people) and the providers of data (data people)

Characteristics Incentives/main objectives Time horizon Main interest Cost orientation Language Communication style Training Familiarity with data/ Substance

Action people Change, Good standing with supervisors Short: days, weeks Relative values (time trends, two regions) Strong Action -oriented, managerial Executive summaries, Business meetings
Administration, Medicin Economics, Management e,

Data people Publication, Detailed report Long: months, years Absolu te values and totals W eak Precise, academic jargon Full reports, written publications, Conferences Statistics, Information, Medicine Excellent/ Limited

Limited/ Excellent

Sybsystems of Health Information System WHO proposes to categorize the health information system under five interrelated subsystems: Epidemiological Surveillance (notifiable infectious diseases, environmental conditions, and risk factors) Routine service reporting Special programmes reporting systems (tuberculosis and leprosy control, MCH, school health) Administrative systems (health care financing systems, health personnel systems, logistic systems)

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Communication Communication process within a health team Feedback process Communication products Time comparison Geographical comparison Comparison of actual performance vs. mean performance Comparison of actual vs. planned performance A framework for defining information needs and indicators Perform a functional analysis at each management level of the health service system Identify information needs and select feasible indicators Patient / Client management Health Unit management Health System management

Indicators

Indicators are variables that help to measure changes, directly or indirectly. - WHO Indicators are variables that indicate or show a given situation, and thus can be used to measure change. - Green Count indicator Proportion indicator Rate indicator Ratio indicator Index o Input indicator o Process indicator o Output indicator o Outcome indicator o Determinant indicator

Data collection instruments

Curative

Data collection instruments for patient/ client management

Medical records Laboratory forms Referral forms

Preventive Growth cards MCH cards School health card Family registration records

Other issues Content (comprehensive) Record filing (patient-retained vs.. health unit-retained) Layout (self-explanatory) Production form Electronic patient record Data collection instruments for health unit management 12

Service delivery records Registers Tally sheets (Abstract register Population charts Resource Management records Health unit report forms Supervisory checklists

Geographical Information System

Definition: GIS can be defined as a set of elements that allow the computerized handling of geographically defined data, their entry, storage, analysis, and presentation Process: Linking an already existing, computerized health information system database to a digitized map Core elements: Geographical data & Attribute data Sources of geographical data: Digitizing maps, Surveys using global positioning systems Sources of attribute data: Routine health information system data, Census data, Survey data, Data from other sectors

HMIS in context of Health Sector Reforms

The more radical and innovative the proposed change is in regard to the information system, the greater the implications for change in the organization Reforms: systemic, programmatic, organizational, & instrumental The objective of producing and utilizing information more effectively will affect the behavior and motivation of all personnel

Hospital Information Systems

Integrated Hospital Information Systems Facilitate Better Care Delivery Healthcare organizations of all sizes face a critical need to manage and integrate clinical, financial and operational information. Reimbursement models are changing; competition is increasing; margins are getting tighter; and the emphasis on patient care and good outcomes has never been higher. As these needs evolve, you require a hospital information system (HIS) that can keep pace. McKesson's Paragon hospital information system delivers, with a single database and common functionality that support integrated ancillary products that allow you to build a system to meet your HIS and budgetary requirements. The Paragon HIS is a completely integrated system of clinical, financial, physician and ancillary applications, addressing your needs for achieving meaningful use requirements of a certified Electronic Health Record (EHR), patient safety, revenue cycle management and more. A single-vendor approach eliminates the inefficiencies and "complexities" frequently found with multi-vendor solutions. From large, multi-entity organizations to community and critical access hospitals, McKesson provides hospital information technology, including certified EHRs, that address the changing needs of healthcare organizations. As part of our Better Health 2020 initiative, McKesson is investing $1 billion in technology R&D in the next two years on future-focused initiatives to help you use healthcare IT more strategically - for better business, better care and better connectivity. 13

Hospital Information Systems (HIS)

Healthcare is a very important part of our society and it is imperative for healthcare providers to do their jobs in an efficient and effective manner. Each day hundreds of thousands of patients enter healthcare facilities challenging the administration to run the show smoothly. The employees have to manage and integrate clinical, financial and operational information that grows with the practice. Previously, this data was organized manually, which was time consuming and failed to deliver the desired level of efficiency. Most professionally run hospitals and clinics now rely on hospital information systems ( HIS ) that help them manage all their medical and administrative information. A hospital information system ( HIS ) is essentially a computer system that can manage all the information to allow health care providers to do their jobs effectively. These systems have been around since they were first introduced in the 1960s and have evolved with time and the modernization of healthcare facilities. The computers were not as fast in those days and they were not able to provide information in real time as they do today. The staff used them primarily for managing billing and hospital inventory. All this has changed now, and today hospital information systems include the integration of all clinical, financial and administrative applications. Modern HIS includes many applications addressing the needs of various departments in a hospital. They manage the data related to the clinic, finance department, laboratory, nursing, pharmacy and also the radiology and pathology departments. The hospitals that have switched to HIS have access to quick and reliable information including patients records illustrating details about their demographics, gender, age etc. By a simple click of the mouse they receive important data pertaining to hospital finance systems, diet of patients, and even the distribution of medications. With this information they can monitor drug usage in the facility and improve its effectiveness. Many hospitals have as many as 200 disparate systems combined into their HIS. Hospital information systems have become very advanced and new innovations are continuously being introduced. But a HIS is useless if it confuses the hospital employees. The system must be user friendly and should include training by the vendors. A good HIS offers numerous benefits to a hospital including but not limited to the delivery of quality patient care and better financial management. The HIS should also be patient centric, medical staff centric, affordable and scalable. The technology changes quickly and if the system is not flexible it will not be able to accommodate hospital growth. An effective HIS also delivers benefits such as: enhances information integrity reduces transcription errors reduces duplication of information entries optimizes report turnaround times

Modern hospital information systems typically use fast computers connected to one another through an optimized network. These computers are programmed to collect, process, and retrieve patient care and administrative information ensuring better ROI and delivery of service. If the hospital authorities have more relevant information they can make better decisions. HIS leverage a highly optimized core library that ensures the delivery of operational and administrative information required by users. A centralized information system can be 14

customized according to the specific requirements of a hospital. A hospital can tell the solution provider its needs and the applications can then be molded to deliver exactly what was demanded. For instance, you can demand a solution that is based on RDBMS for easy retrieval of information. You can also ask the vendor for a HIS that has user friendly features and a multilingual interface that can be used by a diverse workforce. HIS for Different Departments Nursing Information Systems ( NIS ) These computer based information systems are designed to help nurses provide better patient care. A good NIS can perform a number of functions and deliver benefits such as improving staff schedules, accurate patient charting and improve clinical data integration. The nursing department can have a better managed work force through schedule applications enabling managers to handle absences and overtime. The solution can also be used to monitor staffing levels and achieve more cost-effective staffing. Patient charting applications allow users to enter details regarding patients vital signs. Nurses also use it for admission information, care plan and all relevant nursing notes. All important data is securely stored and can be retrieved when required. Clinical data integration is also very useful, allowing nurses to collect, retrieve and analyze the clinical information and then integrate it to design a patients' care plan. All these features in NIS ultimately lead to a reduction in planning time and better assessments and evaluations. The chance of prescribing the wrong medication also decreases since there is always a reference for electronically prescribed drugs. Physician Information Systems ( PIS ) - As the name suggests, PIS systems aim to improve the practice of physicians and are also recommended by the government for deployment. Physicians can avail themselves of the Federal Government stimulus package aimed to provide better medical care. Various packages are available to suit different budgets and can be implemented to increase efficiency, cut costs and deliver high quality patient care. Physician information systems are delivered through computers, servers, networks, and use widely deployed and popular applications such as, electronic medical records (EMRs), electronic health records ( EHRs), and more. Mose of these services have 24/7 remote support that allows hospital staff to troubleshoot problems occurring during system usage. Radiology Information System (RIS) - These systems are also popular for their ability to provide radiology billing services, appointment scheduling as well as reporting and patient database storage. The radiology practice has become more complex with advances in technology and more hospitals now turn to RIS to manage the business side of their practices. Pharmacy Information Systems- Designed to address the demands of a pharmacy department, PIS helps pharmacists monitor how medication is used in hospitals. PIS helps users supervise drug allergies and other medication-related complications. The system allows users to detect drug interactions and also helps administer the proper drugs based on the patients physiologic factors. Selecting a Hospital Information System Total cost of package- Generally, HIS providers are happy to visit and discuss the requirements of your hospital with you. Solutions are available for hospitals of all sizes and 15

budgets. It is important to have a hospital information system that has a low cost of ownership. Some vendors reduce costs by having a design that requires less hardware and fewer servers. This type of design is known to cut upfront acquisition costs and also reduces maintenance in the long run. Web based system- In addition to the user friendly features, a good HIS system must be available on the web. Availability on the web means authorized personnel can access the information whenever they want from anywhere. This does not bind all caregivers to their office desks and also provides them with information when they need it most. A web based system becomes even more important if it is used to share information between two or more hospitals. Healthcare facilities in different geographic locations can share relevant data quickly if they use an internet based HIS. For instance, a hospital may decide to shift a patient to another facility for better care or specialty treatment. If the present hospital has updated all the patient information in their HIS, the second hospital can instantly access the information needed for treatment. The medical history of the patient will always be stored within these facilities and can be readily retrieved if the patient is not able to provide it himself. Implementation and support- Change is always resisted by humans and deploying or upgrading a hospital information system may also invite employee criticism. It is always better to ask the vendor for support in an implementation and request for staff training. Choose a vendor that offers 24x7 support via the telephone or web, so your hospital staff can immediately access support. Some hospitals also consult their staff while making a purchasing decision, as the staff may be able to tell you something new or inform you about things others may have overlooked. 2013 EHR Scope, LLC All Rights Reserved. Tel 888.519.3100

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