Integrated computerized patient records: a two-year Geneva experience (original) (raw)
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.
Integrating Hospital Information Systems. The challenges and advantages of (re-)starting now
Proceedings / the ... Annual Symposium on Computer Application [sic] in Medical Care. Symposium on Computer Applications in Medical Care
With the new technologies available today, more complex and useful Hospital Information Systems (HIS) can be designed and implemented. These new technologies have allowed that information from different sources and nature such as documents, images and signals be integrated within a single environment. Open standards, reliable networks, powerful hardware and software and lower prices are among the issues that make all this possible. One of the main issues is what to do with old systems that do not adhere to this new HIS concept. At the Heart Institute (InCor), a decision was made towards starting developing a new system called I3S. This paper gives a brief description of that system.
Annals of Internal Medicine, 1991
Improvement in clinical information-management systems is frequently cited as one strategy for coping with the cost and inefficiency of our health-care system. However, dissemination of computer-based records has been slow and fraught with logistical complications. The Institute of Medicine (IOM) recently undertook an 18-month study to examine the status of patient records and of computer-based approaches to their management. The study examined current and future users and uses of patient records plus technologies to support record automation. Strategies were then developed to address the barriers to widespread adoption of computerbased records. Solutions depend on a coordinated national, regional, and institutional approach to computing and communications infrastructure. Physicians may wish to familiarize themselves with the final report, in which the IOM has recommended that the public and private sectors join in establishing a Computer-Based Patient Record Institute to promote and facilitate development, implementation, and dissemination of computer-based records.
An Integrated Healthcare Information System: Toward New Technologies
This paper presents several aspects of the migration of a former implementation of a prestige Project ("ICPC2000") toward the new Microsoft.NET technology. This project and its extensions has as a result an integrated primary care information system that allow information storing/retrieving and exchange for a GP network and the related entities (County Health Insurance Houses -CHIH, hospitals, laboratories, pharmacies etc.). The former results are described, in order to understand the structure and the functions of the integrated information system suggested. Then, the new structure is described, with emphasizis on the specific aspects this approach: WEB services. Several considerations about the migration are presented and conclusions are issued.
ARIANE: integration of information databases within a hospital intranet
International Journal of Medical Informatics, 1998
Large information systems handle massive volume of data stored in heterogeneous sources. Each server has its own model of representation of concepts with regard to its aims. One of the main problems end-users encounter when accessing different servers is to match their own viewpoint on biomedical concepts with the various representations that are made in the databases servers. The aim of the project ARIANE is to provide end-users with easy-to-use and natural means to access and query heterogeneous information databases. The objectives of this research work consist in building a conceptual interface by means of the Internet technology inside an enterprise Intranet and to propose a method to realize it. This method is based on the knowledge sources provided by the Unified Medical Language System (UMLS) project of the US National Library of Medicine. Experiments concern queries to three different information servers: PubMed, a Medline server of the NLM; Thériaque, a French database on drugs implemented in the Hospital Intranet; and a Web site dedicated to Internet resources in gastroenterology and nutrition, located at the Faculty of Medicine of Nice (France). Accessing to each of these servers is different according to the kind of information delivered and according to the technology used to query it. Dealing with health care professional workstation, the authors introduced in the ARIANE project quality criteria in order to attempt a homogeneous and efficient way to build a query system able to be integrated in existing information systems and to integrate existing and new information sources.
Samevatting A prototyping approach was used to determine the essen tial system requirements of a computerised patient record information system for a typical township primary health care clinic. A pilot clinic was identified and the existing manual system and business processes in this clinic was studied intensively before the first prototype was imple mented. Interviews with users, incidental observations and analysis of actual data entered were used as primary techniques to refine the prototype system iteratively until a system with an acceptable data set and adequate functionalities were in place. Several non-functional and user-related requirements were also discovered during the prototyping period.
2008
A Survey on the compatibility of the Hospital Information Systems (HIS) with the needs of medical records users from the system Introduction: The use of a computerized system improves the effectiveness and efficiency of a medical record department, when managers and medical record staff design it according to their needs. Methods: The present study is an applied-descriptive study. The first checklist is provided from professional texts, articles and internet. Having interviewed with medical record users, the researcher determined their needs in general requirements of HIS, general requirements of medical records department, medical records management, admission, discharge, statistics, coding, filing and chart completion. Then the characteristics of systems were determined by means of observations and questions; and the percentage of compatibility between systems and needs of medical record users was calculated. Results: Our findings showed that totally; average of compatibility between systems and needs of medical records users is 54 %. There are the least conformity in coding and filing and chart completion and the most conformity in medical records management and discharge. Our findings also showed that the users' needs are regarded by venders of systems and often they have met earlier and more important needs. Conclusion: It is imperative that venders with support of managers regard more and more to users needs in order to improve systems.