Hospital information systems hospital as a big complicated healthcare organisation
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Danny Solomon Senior Architect, iSOFT [email protected] Hospital Information Systems “ Hospital” as a big complicated healthcare organisation. Understand information requirements of hospitals and other health-care organisations

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Hospital Information Systems “ Hospital” as a big complicated healthcare organisation

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Danny Solomon

Senior Architect, iSOFT

[email protected]

Hospital Information Systems“Hospital” as a big complicated healthcare organisation

Understand information requirements of hospitals and other health-care organisations

Understand issues and challenges in the life-cycle of health-care information-systems

Understand some of the history – and some future directions

Introduce iSOFT





What is a health-care information system? What’s it for?

Issues in their creation and deployment – why is it hard?

Where they have come from – where they are going





How it all relates to CfH

What is a health-care information system? What’s it for?

Requirements of a health-care information system

  • Information-systems to run health-care organisations (HCOs)?

  • OR

  • Information-systems to manage the records of patients cared for in those organisations?






Mental Health



Directory and desktop


Population record

Records Analysis


Out-of hours access

Reference data



Service user index

Clinical governance

Booking and scheduling

Knowledge mgt

Digital Imaging


Orders and results

Diagnosis and care


Any community service for tactical reasons

Eg. PAS, Mental Health, Tertiary

Non-federated data

. . .

What is an HCO?

Guys &



Clinical information









Multiple facilities (sites)



Diagnostic services

Radiology, Pathology, etc



Theatres, Modalities

Medical Records


Links to other organisations

Local: Primary care, Community

National: DoH, CfH, national information systems






HR, Finance, etc

Anatomy of a hospital

Information-systems to run health-care organisations

  • What’s going on?

  • What’s planned?

  • Where are my patients?

  • What reports do I need to generate?

  • Get my money

  • Am I about to run out of money?

  • Run my clinics

  • Run my waiting lists

  • Run my wards

  • Run my theatres


Where do they live

Booked for a clinic?

On a ward?


Next of kin


What’s wrong with them

What am I planning to do to them?

Order a test

See the result

Refer them on

Describe them

Information systems to manage patient records

Division is not clear cut

  • Information Governance (IG) issues

    • Who can see what?

    • Is restricting to demographics safe?

    • Who can see clinical?

    • Is ward location clinical or demographic?

    • How much information is shared? To whom?

    • What does the patient expect?

Issues in the creation and deployment of health-care information systems

  • Why is it hard?

  • Total cost of ownership (TCO)

Why is it hard?

  • Well, is it hard?

    • Empirical evidence suggests it is

    • Beacon examples are generally not reproducible

    • Productising is an issue

  • Medicine is not a science

  • Out of the box, computers are good at numbers, not people

  • Organisational setting is complex

    • Different across different markets

  • Change control and management is always hard

  • Some specifics…

Why it is hard

  • Booking a clinic is like booking a flight?

    • Slots not constant

    • Different resources required for different slots/clinics

    • Recipient has to explicitly accept

    • Over-booking rules

    • Patients aren’t predictable …

  • Clinic booking is the easy bit!

Why it is hard

  • Lots of different kinds of users

    • Clinicians

      • Docs

        • Different grades, specialties, experiences, training, backround

      • Nurses

      • PAMS

    • Managers

    • Administrative staff

    • Patients

      • Well

      • Unwell

      • Worried well

      • Vulnerable

      • Young / old

      • Expert / non-expert

Why it is hard

  • Lots of different kinds of users

  • Doing different kinds of things

    • Seeing patients

      • Clinics, wards, A&E, telephone

    • Planning budgets

    • Organising resources

      • Human, equipment, consumable, locations

  • In many different settings

    • Organisational

      • Hospital (wards, clinics…), Community, Practice, Lab,

    • Specialty

      • Paed, Geri, Med, Surg, …

  • Everyone likes to do things their own way

Don’t panic

Maintaining the balance

There is commonality we can exploit

Healthcare services

Care settings

Health economy

One product, many solutions

Product vs solution

  • Product = software

  • Solution = software configured and deployed onto a managed technical architecture

    • Many areas to consider: TCO

Total cost of ownership (TCO)

  • Forget shelf prices

  • What will it cost my organisation to procure, contract, implement, run, update and ultimately retire an information system?

  • What if I do nothing?

  • A useful way of examining areas that make this whole process hard

Typical TCO model

Health-care information systems: where they have come from & where they are going



Direction of travel

Past, present and Future

Where health-care information systems have been

  • Organisation often based on physical artefacts

    • Eg Hospitals

    • Lots of local autonomy

    • Need to maintain links with labs

    • Maintain own coding departments

    • Maintain own IT infrastructure

  • Information systems

    • Local procurement

    • PAS critical

    • Clinicals less so

      • Lots of local activity at a departmental level – nightmare to manage

    • Order-comms typically an early requirement/win

    • EPR / Prescribing not common in secondary care


  • Health-care organisation is changing

    • Everywhere, quite frequently

    • From the centre

      • Reporting requirements

      • Spine compliance

      • PBR

    • Locally

      • (some) clinicians demanding better tools

      • Access to knowledge & best practice, decision support, lose the paper

  • Procurement model is changing

    • Local  Regional  National

    • Do once and share

      • Procurement, configuration


  • Health-care organisation is changing

  • Procurement model is changing

  • Deployment model is changing

    • Critical data under a GP’s desk?

    • Critical data in a hospital server-room?

    • DR-capable data-centre

  • Information-sharing becoming critical

    • Support the patient journey

    • Empower the patient

      • Where that’s a good thing

    • Avoid unnecessary errors








Step 1 – Analyse landscape

Qualify legacy systems

Plan the transition

Step 2 – Install products

Legacy replacement commenced

Service adapters for core services deployed

Service hubs introduced

Architecture being delivered

Step 3 – Join Up

More uniform landscape

More information access

Common services and accessible data

Supports shared and coherent care across the community

User experience:

Mix of modern and legacy

Organisation-focused: little information passed around the community

User experience:

Modern applications becoming pervasive

Information becoming accessible across the community

Legacy decreasing

User experience:

Modern applications across the community

Information accessible across the community

GP legacy


Healthcare community

Hospital legacy

iSOFT customer

Integrated healthcare community

Direction of travel


Market leadership

Business strategy

Global healthcare and social reform


To be the global leader in the healthcare software applications market.

iSOFT is working with patients, clinicians, other healthcare professionals, administrators and governments to help transform the delivery of healthcare.

We focus on satisfying the needs of all individual stakeholders, whoever they are, and however they participate in the supply chain of healthcare provision. Our solutions not only meet the current need, they also describe the future of healthcare.

Our inspiration and motivation is to improve the life experience of citizens worldwide

Our mission

  • iSOFT: inspired by life.

Leading the healthcare software applications market


Scale of business

  • Customers

    • 1,700 hospitals

    • 6,000 family doctors

    • 18 countries in five continents

  • Employees

    • 2,700 healthcare IT specialists

    • 1,000 technology and development professionals

    • Two dedicated offshore development and solution design centres in India

  • Fourth largest software and computer services business on the LSE

  • Market capitalisation of over £900m (US$1,600 million)

  • Stock market listing in July 2000

    • Revenues grown from £17m to £262m

    • Profits increased by over 2,000%




Target rapid




growth in

existing markets

Develop and

execute new

market entry






  • Develop and grow existing market shares for LORENZO

  • Configure LORENZO to meet local market requirements

  • Provide world class references for international expansion

  • Conduct detailed market analysis and qualification

  • Establish strong foundation based on significant early wins

  • Build on initial success through effective promotion of LORENZO

  • Establish leading competitive position

  • Win majority of open market procurements

  • Accelerate market share through targeted acquisitions

  • Work with third party technology and service partners on large scale projects and new market entry

  • Develop existing partnership arrangements

  • Identify opportunities for new partnerships and collaborations

  • Offer strategic ‘universal’ application set

  • Continue to invest in development capability and capacity

  • Promote LORENZO as our new generation software solution

Our business strategy

The needGlobal healthcare and social reform

  • Healthcare is undergoing rapid, unprecedented change

  • Forward referencing solutions required by citizens, clinicians, policy makers

  • Work to implement the necessary systems will take place over the next 10 years


  • Successful well managed healthcare applications business

  • Consistent and focused business strategy

  • Large and growing international market opportunity

  • Leader in the supply of advanced application solutions

  • Strong positive differentiation from small number of credible competitors

  • Well positioned in respect of future growth opportunity in both existing and new international markets

Understand information requirements of hospitals and other health-care organisations

Understand issues and challenges in the life-cycle of health-care information-systems

Understand some of the history – and some future directions

Introduce iSOFT

Re-cap Objectives

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