Integrated computerized patient records: a two-year Geneva experience (original) (raw)
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An Interface Between a Hospital Information System and a Computerized Medical Record
There is a growing overlap between hospital information systems and medical information systems in both data storage and function. The development of an integrated system is the best approach to reducing redundancy without compromising function. An initial interface has been established between the hospital information system and a medical information system at Duke Univeristy as the first step toward achieving an integrated data base.
Journal of Medical Systems, 1989
Program (DHCP) contains data modules derived from separate ancillary services (e~g., Lab, Pharmacy and Radiology). It is currently difficult to integrate information between the modules. A prototype is being developed aimed at integrating ancillary data by storing clinical data oriented to the patient so that there is easy interaction of data from multiple services. A set of program utilities provides for user-defined functions of decision support, queries, and reports. Information can be used to monitor quality of care by providing feedback in the form of reports, and reminders. Initial testing has indicated the prototype's design and implementation are feasible (in terms of space requirements, speed, and ease of use) in outpatient and inpatient settings. The design, development, and clinical use of this prototype are described. THE DHCP ENVIRONMENT The DHCP is a composite of several software modules. Some of these modules (Medical Administration Service, Laboratory, Pharmacy) are running in all of the participating 169 VA hospitals; other modules (Surgery, Radiology, Nursing) are currently only used at some hospitals. Individual medical centers have a wide latitude in the implementation of the ancillary packages. Most modules allow for site-configurable setup of the clinical database. Formularies, test lists, procedures, reference ranges of test values, and user menus can be changed to meet local needs. Technically, the DHCP is very integrated. All software is operating on the same system (a network of DEC PDP 11 or VAX hardware at each facility), in the same computer language (MUMPS), conforming to common programming rules and standards.
Informatics
The evolution of technology in clinical environments increases the level of precision in patient care, as well as optimizes the management of healthcare centers. However, the need to have information systems that are more sophisticated and require interoperability between them means that a great deal of effort has to be made to assume the maintenance and scalability of the systems. Therefore, a proposal for a standard information model for the integration of clinical systems in a healthcare environment is presented. In order to elaborate the model, an analysis of the functional needs of the different clinical areas of a clinical environment is made based on the information systems that make up the system and application map. An evaluation of the technical requirements and the technological solutions that can satisfy these requirements is also carried out, delving into the different technical alternatives that allow the exchange of information. From the analysis carried out, an integ...
Happy birthday DIOGENE: a hospital information system born 20 years ago
International Journal of Medical Informatics, 1999
Since its birth in 1978, DIOGENE, the hospital information system of Geneva University Hospital has been constantly evolving, with a major change in 1995, when migrating from a centralized to an open distributed architecture. For a few years, the hospital had to face health policy revolution with both economical constraints and opening of the healthcare network. The hospital information system DIOGENE plays a significant role by integrating four axes of knowledge: medico-economical context for better understanding and influencing resources consumption; the whole set of patient reports and documents (reports, encoded summaries, clinical findings, images, lab data, etc.), patient-dependent knowledge, in a vision integrating time and space; external knowledge bases such as Medline (patient-independent knowledge); integration of these patient-dependent and independent knowledge in a case-based reasoning format, providing on the physician desktop all relevant information for helping him to take the most appropriate adequate decision
Introduction to hospital information systems
International Journal of Clinical Monitoring and Computing, 1987
The phrase, 'hospital information system', is frequently used in discussions about the flow of information throughout a hospital with the assumption that everybody has the same concept in mind. Closer examination shows that this is not necessarily the case. The author draws on his experience as the Chief Information Officer at University Hospital at Stony Brook to define a hospital information system in terms of the implementation at Stony Brook. The University Hospital Information System at University Hospital (UHIS), has received international acclaim and was recently selected by the IBM Quarterly of Australia as the world leader in hospital information systems. This paper answers four questions: 1. What is a hospital information system? 2. How does a hospital information system work? 3. How do you implement a hospital information system? 4. After the system is operational, where do you go, e.g., critical care data management, physician's office management? University Hospital at Stony Brook is located on eastern Long Island and is the tertiary care referral hospital for approximately 1.4 million people. Nothing in the hospital happens without computers. Doctors, nurses, administrators and staff at all levels rely on the system daily. The system operates 24 hours per day, seven days per week. Access to the system is through 300 terminals and 128 printers throughout the hospital. In addition to the UHIS terminals, the critical care management system which is called Patient Data Management System, (PDMS), is available at over 90 ICU beds and in the operating rooms.
Computerized patient record system
The computer-based patient-record system can play a significant role in physicians' decision-making process by, for instance, presenting them with information they need from the record, relevant to care situations. However, the patient-record system's contribution in decision making is often reduced to storing and presenting patient information as time-oriented logs of encounter events. As the record accumulates patient information over time, physicians loose overview over the contents, and the information becomes increasingly inaccessible for them.
The Evolution of a Computerized Medical Information System
This paper presents the eighteen year history leading to the development of a computerized medical information system and discusses the factors which influenced its philosophy, design and implementation. This system, now called TMR, began as a single-user, tape-oriented minicomputer package and now exists as a multi-user, multi-database, multi-computer system capable of supporting a full range of users in both the inpatient and outpatient settings. The paper discusses why we did what we did, what worked, and what didn't work. Current projects are emphasized including networking and the integration of inpatient and outpatient functions into a single system. A theme of the paper is how hardware and software technological advancements, increasing sophistication of our users, our increasing experience, and just plain luck contributed to the success of TMR.
Vision of an'automated'hospital information system
1998
This paper tries to describe a coherent vision of a possible next generation of HIS that rethinks how and what for computing is used in hospitals. Current systems, organized mainly around the `database` and the `communication` paradigm help the data processing to a great extent. At the same time they cannot be accepted as 'automated' systems, as handling of information is done mostly by end-users, i e. by human actors. Emerging methods enabling automated information handling are the following: integrated handling of different media, seamless communication among different systems, alternative input-output devices, tools for pro-active information handling These technologies should be grouped to two main branches: technical advances in data handling and theoretical advances in knowledge handling. The advances in knowledge handling are really important: tools based on that can take over routine information handling tasks from human end users. To discuss automation in HIS it is useful to understand the process of information handling in general within the hospital. A suggested multidimensional information space, where information objects are gathered mainly along two axes, the 'patient axis' and the 'management' axis might be of help. Combinations of selected dimensions resulted in a space of an estimated 2294082 possible information handling situation types in an earlier publication. Automation of information handling tasks can be derived from this model. The authors suggest to automate certain tasks done usually by active actors of the information handling situation space. Software agents working 'on their own' are known entities in HIS systems. Two components are needed for automation: -an organized data base where itscontent can be 'understood' and interpreted by an algorithm, with other words a knowledge base -an algorithm, that covers a certain routine information handling task. Data bases of HIS should be re-thought in a way that enables automated processing to a greater extent. The development of data base technologies clearly point to this direction. If most of the data bases of a HIS will be like that, new generation of applications might be launched to use them. E.g. a software agent called 'patient assistant' could collect data from different sources and build a coherent and updated patient file. The results of a knowledge based, agent operated HIS should be the following: -significantly less direct human involvement -significantly less paper to be produced -enhanced speed of data flow in general -enhanced reliability by widespread watchdog functions
Journal of Digital Imaging, 1996
The fragmentation of the electronic patient record among hospital information systems (HIS), radiology information systems (RIS), and picture archiving and communication systems (PACS) makes the viewing of the complete medical patient record inconvenient. The purpose of this report is to describe the system architecture, development tools, and implementation issues related to providing transparent access to HIS, RIS, and PACS information. A client-mediator-server architecture was implemented to facilitate the gathering and visualization of electronic medical records from these independent heterogeneous information systems, The architecture features intelligent data access agents, run-time determination of data access strategies, and an active patient cache. The development and management of the agents were facilitated by data integration CASE (computer-assisted software engineering) tools. HIS, RIS, and PACS data access and translation agents were successfully developed. AII pathology, radiology, medical, laboratory, admissions, and radiology reports for a patient are available for review from a single integrated workstation interface. A data caching system provides fast access to active patient data. New network architectures are evolving that support the integration of heterogeneous software subsystems. Commercial tools are available to assist in the integration procedure.