HOSPITAL INFORMATION SYSTEM
دوستان علاقه مند به HIS که از من در مورد جزئیات و ساختار HIS سوال می کردند یک متن خوبی را انتخاب کرده و در صفحه وب می گذارم که ادامه یکی از مقالات کوتاه قبلی است که با ترجمه گذاشته بودم. امیدوارم مورد توجه قرار گیرد.
What is HIS
A hospital information systems (HIS) is a computer system that is designed to manage All the hospital’s medical and administrative information in order to enable health professional perform their jobs effectively and efficiently.
Hospital information systems were first developed in the 1960s and have been an essential part in hospital information management and administration. Early systems consisted of large central computers connected to by dumb terminals, which are now being replaced by networked microcomputers. The systems were used to manage patient finance and hospital inventory.
Hospital information systems now focus on the integration of all clinical, financial and administrative applications and thus could also be called an integrated hospital information processing systems (IHIPS).
Components a hospital information system consist of two or more of the following:
(CIS) - Clinical Information System
(FIS) - Financial Information System
(LIS) – Laboratory Information System
(NIS) – Nursing Information System
(PIS) – Pharmacy Information System
(RIS) – Radiology Information System
(PACS) - Picture Archiving Communication System
A Look at the list above shows how complex a hospital information system can be.
Advancement in computer technology and the development of information exchange standards such HL7 and DICOM, make the task administering and integrating such systems a little more easier.
No hospital information system can be regarded as a success unless it has the full participation of its users. Thus human and social factors would have to be considered in its design, more often than not, they can be easily addressed by providing adequate training and education about the system.
CIS
CLINICAL INFORMATION SYSTEM
A Clinical Information System (CIS) is a computer based system that is designed for collecting, storing, manipulating and making available clinical information important to the healthcare delivery process.
Clinical Information Systems may be limited in extent to a single area (e.g. laboratory systems, ECG management systems) or they may be more widespread and include virtually all aspects of clinical information (e.g. EMR).
Clinical Information Systems provide a clinical data repository that stores clinical data such as the patient’s history of illness and the interactions with care providers. The The repository encodes information capable of helping physicians decide about the patient’s condition, treatment options, and wellness activities as well as the status of decisions, actions undertaken and other relevant information that could help in performing those actions.
Some of the areas addressed by Clinical Information Systems are:
Clinical Clinical Decision Support : This provides users with the tools to acquire, manipulate, apply and display appropriate information to aid in the making of correct, timely and evidence-based clinical decisions.
EMRs - Electronic Medical Records : this contains information about the patient, from their personal details, such as their name, age, address and sex to details of every aspect of care given by the hospital (from routine visits to major operations).
Training and Research: Patient information can be made available to physicians for the purpose of training and research. Data mining of the information stored in databases could provide insights into disease states and how best to manage them.
Fore years, research has been done to show the value of Clinical Information Systems, and these have highlighted not just the benefits but also the barriers that might be faced by hospitals who implement such systems.
Some of the benefits are:
Easy Access to Patient Data: Clinical Information Systems can provide convenient access to medical records at all points of care. This is especially beneficial at ambulatory points, hence enhancing continuity of care. Internet-based access improves the ability to remotely access such data.
Structured Information: The clinical information captured in Clinical Information Systems is well organised, thus making I easier to maintain and quicker to search through for relevant information. The information is also legible, making it less likely that mistakes would be made due to illegible writing.
Improved Drug Prescription and Patient Safety: Clinical Information Systems improve drug dosing and this leads to the reduction of adverse drug interactions while promoting more appropriate pharmaceutical utilization.
Despite the benefits being offered by Clinical Information Systems, they are not without the barriers that prevent them from being rolled out in every hospital. These include some of the following:
Initial cost of acquisition: the high cost of basic infrastructure of clinical information technology can be a stumbling block to many healthcare organizations.
Privacy Privacy and Security: There are still huge concerns in the healthcare industry about the privacy of patient data on computer systems and how to keep such information secure. The HIPAA and Data Protection Act passed by respective governments in the US and the UK were introduced to address some of these concerns.
Clinician Resistance: Clinicians usually have 10-20 minutes to see their patients and if their interactions with a CIS during these sessions proves to be counterintuitive by taking up more time than is necessary, there is bound to resistance to it use.
Bound to resistance to it use.
Integration of Legacy Systems: This poses a stiff challenge to many organizations.
FIS
FINANCIAL INFORMATION SYSTEM
Financial Information Systems (FIS) are computer systems that manage the business aspect of a hospital. While healthcare organisations’ primary priority is to save lives and not making profits, they do acquire running costs from day to day operations; including purchases and staff payroll.
Healthcare business activities can be quite complex and the introduction of Financial Information Systems aims to ease that daunting task that faces hospitals.
Some of the features of Financial Information Systems are:
PAYROLL: Handles all the recurring and non-recurring payments and deductions for employees. All recurring transactions can be automatically generated each payroll period with non-recurring transactions such as overtime added to the payroll upon approval. It is also possible to maintain employee pay rates, entitlements, full salary movements and payroll histories.
PATIENT ACCOUNTING: This concentrates on financial transactions generated during a patient’s visit to the hospital. These include inpatient and outpatient charges, doctors’ fees generated across the hospital, the cost of procedures, operations and medications.
ACCOUNTA PAYABLE : Handles the processing of invoices and payments within the hospital.
ACCOUNTS RECEIVABLE: This provides support for and the maintenance of the records of all clients, invoices and payments.
GENERAL LEDGER : This handles the collection, processing and reporting of financial data generated by all transactions, enabling a current, accurate and instant view of the financial status of the hospital at any point in time.
FIXED ASSET MANAGEMENT : This deals with asset data retention and depreciation forecasting. The transfer of fixed assets between locations, cost centres or departments; reclassification of assets and reassessments of asset values can functions that can be done by the Financial Information System.
CLAIMS MANAGEMENT: Manages all claims that are made to insurance companies.
CONTACT MANAGEMENT : Keeps track of all ongoing contracts.
LIS
LABORATORY INFORMATION SYSTEMS
A laboratory information system (LIS) is a computer information system that manages laboratory information for all the laboratory disciplines such as clinical chemistry, haematology and microbiology.
Laboratory Information Systems provide modules for sending laboratory tests order to the instruments through its multiple instrument interfaces, some are known as to have as many as five hundred, track those orders and then capturing the results as soon as they become available. The result can then be analysed and a report the generated from it.
This report can be sent off for printing at a specific point, sent off to other systems either to be added to patient’s electronic medical record or for billing.
Laboratory Information Systems communicate with other information systems using clinical information standard such as HL7. Laboratory systems might also make use of LONIC (Laboratory Observation Identities, Names and Codes) to exchange laboratory results with other systems.
Other features that include:
Patient management: Patient details like the admission date, admitting physician, and admission number can be maintained by a Laboratory Information System. Other information concerning the patient’s specimen including the ordering physician, department ordering the test, specimen type, date/time of collection and receipt, and the initials of the collecting technician, can also be managed in a Laboratory Information System.
Decision Support: Lab orders can be cross-referenced against classification codes such as ICD-9 and LONIC, and also verified that that the correct test is being carried out.
Patient Tracking: A patient tests can be catalogued and called up when the need to review them comes up.
Quality Assurance: Ensures that the tests carried out using the currently available standards.
Management Reporting
Workload Recording.
NIS
NURSING INFORMATION SYSTEM
Nursing information systems (NIS) are computer systems that manage clinical data from a variety of healthcare environments, and made available in a timely and orderly fashion to aid nurses in improving patient care.
To achieve this, most Nursing Information Systems are designed using a database and at least one nursing classification language such as North American Nursing Diagnosis (NANDA), Nursing Intervention Classification (NIC) and Nursing Diagnosis Extension and Classification (NDEC).
Some of the features that are provided by Nursing Information Systems include:
Patient Charting: A patient’s vital signs, admission and nursing assessments, care plan and nursing notes can be entered into the system either as structured or free text. These are the stored in a central repository and retrieved when needed.
Staff Schedules: Nurse can self schedule their shifts using scheduling rules provided in shift modules. The shifts can later be confirmed or changed by a scheduling coordinator or manager. Shift modules are designed to handle absences, overtime, staffing levels and cost-effective staffing.
Clinical Data Integration: Here clinical information from all the disciplines can be retrieved, viewed and analysed by nursing staff and then integrated into a patient’s care plan.
Decision Support: Decision support module can be added to Nursing Information Systems, and they provide prompts and reminders, along with guides to disease linkages between signs/symptoms, etiologies/related factors and patient populations. Online access to medical resources can also be made available.
There are benefits to be enjoyed by implementing Nursing Information Systems and they includ:
Improved workload functionality: Staffing levels and appropriate skill mix per shift can be more easily determined by the shift modules. This leads to less time spent in designing and amending rosters.
Better care planning: Time spent on care planning is reduced, while the quality of what is recorded is improved. This makes for more complete care plans and more complete assessments and evaluations.
Better drug administration: Electronically prescribed drugs are more legible, thus making it less likely that drugs would be wrongly administered to patients.
Despite the benefits Nursing Information Systems have to offer, they are not widely used in healthcare and where they have been installed, they have not been readily accepted. This could probably due to lack of adequate training and failure of educate the end-user what the reasons are for its introduction. Moreover, very little research has been done to determine the cost benefits or cost effectives of such information systems.
PIS
PHARMACY INFORMATION SYSTEMS
Pharmacy information systems (PIS) are complex computer systems that have been designed to meet the needs of a pharmacy department. Through the use of such systems, pharmacists can supervise and have inputs on how medication is used in a hospital.
Some of the activities which Pharmacy Information Systems have been employed in pharmacy departments include:
Clinical Screening: The Pharmacy Information System can assist in patient care by the monitoring of drug interactions, drug allergies and other possible medication-related complications. When a prescription order is entered, the system can check to see if there are any interactions between two or more drugs taken by the patient simultaneously or with any typical food, any known allergies to the drug, and if the appropriate dosage has been given based on the patient’s age, weight and other physiologic factors. Alerts and flags come up when the system picks up any of these Prescription Management: The Pharmacy Information System can also be use to mange prescription for inpatients and/or outpatients. When prescription orders are received, the orders are matched to available pharmaceutical products and then dispensed accordingly depending on whether the patient is an inpatient or outpatient. It is possible to track all prescriptions passed through the system from who prescribed the drug, when it was prescribed to when it was dispensed. It is also possible to print out prescription labels and instructions on how medication should be taken based on the prescription.
Inventory Management: Pharmacies require a continuous inventory culture in order to ensure that drugs do not go out of stock. This is made even more difficult when there are multiple dispensing points. When don manually it is very difficult to maintain an accurate inventory. Pharmacy Information Systems aid inventory management by maintaining an internal inventory of all pharmaceutical products, providing alerts when the quantity of an item is below a set quantity and providing an electronic ordering system that recommends the ordering of the affected item and with the appropriate quantity from approved suppliers.
Patient Drug Profiles: These are patient profiles managed by the Pharmacy Information System and contain details of their current and past medications, known allergies and physiological parameters. These profiles are used for used for clinical screening anytime a prescription is ordered for the patient.
Report Generation: Most Pharmacy Information Systems can generate reports which range from determining medication usage patterns in the hospital to the cost of drugs purchased and /or dispensed.
Interactivity with other systems: It is important that Pharmacy Information Systems should be able to interact with other available systems such as the clinical information systems to receive prescription orders and financial information system for billing and charging.
RIS
RADIOLOGY INFORMATION SYSTEM
A radiology information system (RIS) is a computer system that assists radiology services in the storing, manipulation and retrieving of information.
RIS were first used in the 1970s and their primary aim was to manage and store radiology information.
The introduction of client/server computing, improved digital imaging and computer network technologies, along with the advancement of the DICOM and HL7 standards have put RIS along side picture archiving communication system (PACS) as an ideal solution for managing radiological images.
Since the 1990s, organisations have taken the steps to fully integrate PACS with radiology information systems, when the basic features and adapt needed to mange the acquisition, processing and storage of radiological information, becomes the responsibility of the RIS.
Some of the areas that can be addressed by radiology information systems are:
Patient Management: radiology information systems can be used to manage a patient’s entire workflow within the radiology department, images and reports can be added to and retrieved from electronic medical records (EMRs) and viewed by the authorised radiology staff.
Scheduling: Patient appointments for inpatients and outpatients can be scheduled when an order is received. Functions for scheduling the various available radiology staff with the allocated time slots can also be handled by the radiology information system.
Patient Tracking: The patient can be tracked from admission to discharge, with all the radiology procedures carried out recorded. This would include the patient’s past, present and future appointments.
Results Reporting: Reports concerning the results of an individual patient, a group of patients or a particular procedure can be generated using a radiology information system.
Film Tracking: Individual films can be tracked.
PACS
PACS (PICTURE ARCHIVING COMMUNICATION SYSTEM)
Picture Archiving Communication System (PACS) is a loose term to describe a set of systems that facilitate the archiving, processing and viewing of digital radiological images and their related information.
The images are acquired, archived and retrieved over a network for diagnosis and review by physicians. These images can be interpreted and viewed at workstations, which can also double as archive stations for image storage.
The introduction of client/server computing, improved digital imaging and computer network technologies, along with the advancement of the DICOM and HL7 standards have put PACS along side radiology information systems (RIS) as an ideal solution for managing radiological images. Some of these images include:
X-ray photos
Cycloplegia Retinoscopy
Computed Tomography
Magnetic Resonance Imaging
Radio Isotope
Ultrasound
PACS first emerged in the 1980s, although initially trumpeted as a solution to lost films, healthcare organisations, especially the larger ones, have found that digital images can easily be lost as well.
One of the main benefits that PACS provides is the ability to provide a timely delivered and efficient access to images, interpretations and related data throughout the organisation. This helps to ease consultations between physicians who can now simultaneously access the same images over networks, leading to a better diagnosis process.
It is also beneficial to physicians in emergency situations, as they need not wait for long periods in order to view a patient’s radiological images as these are instantly available on the network when ready.
Another feature of PACS is the ability to digitally enhance the images, providing more detailed and sharper images. This improves diagnostic capabilities at radiological examinations.
Since the 1990s, organisations have taken the steps to fully integrate PACS with RIS, when the basic features and adapt needed to mange the acquisition, processing and storage of images, becomes the responsibility of the PACS.
The high costs of PACS has led to vendors offering mini-PACS, which is a cheap alternative for organisations that cannot afford the cost of a full PACS system or those seeking to implement seeing to implement some form of a digital image management system but would rather start off with something small.
While PACS are considered to be at a minimum hospital wide, mini-PACS usually tend to be departmental-based (radiology, emergency room, or orthopedics). Mini-PACS are easy to maintain and cheap to repair, and they can gradually be upgraded to a fully functioning hospital wide PACS.
Advantages of PACS
Rapid access to critical information to decrease exam-to-diagnosis time. This is especially useful in emergency and operating rooms.
Elimination of film, handling and storage cost.
Images can be easily shared between reading radiologists, other physicians and medical records.
Images can be archived at secure locations using database servers manages the transfer, retrieval and storage of images and relevant information; the archive provides permanent image storage.
Radiologists can access soft-copy images instantly after acquisition to expedite diagnosis and reporting at the almost any available workstation.
Web servers can be used to most cost-effectively share images with other departments, even referring physicians across town. They can access the images using the Internet or the local intranet.
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