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Intranet Technology in Hospital Information Systems

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  1. Intranet Technology in Hospital Information Systems James J. Cimino, M.D. Department of Medical Informatics Columbia University

  2. Accessing Clinical Information over the Internet and World Wide Web James J. Cimino, M.D. Department of Medical Informatics Columbia University

  3. Web Access to the EMR atColumbia-Presbyterian Medical Center James J. Cimino, M.D. Department of Medical Informatics Columbia University

  4. CPMC in 1988 - preTCP/IP IBM Mainframe Data Repository Data Monitor Vocabulary Server Results Review Ancillary Systems Clinicians

  5. CPMC in 1991 - TCP/IP IBM Mainframe Data Repository Data Monitor Vocabulary Server Results Review Intranet Minicomputer Minicomputer Upload Engine Clinical Application Vocabulary Server Vocabulary Server Ancillary Systems Clinicians

  6. CPMC in 1994 - WWW IBM Mainframe Data Repository Data Monitor Intranet Minicomputer Internet Web Server Internet Vocabulary Server Knowledge Resources Clinicians

  7. Clinical Database • Row-oriented relational database (DB2) • Flexible and extensible • Clinical data coded with MED • Multiple time stamps

  8. Data Monitor - Input and Alerts • Stores all data in repository • Checks data for triggers • Executes Medical Logic Modules • Stores alerts in database

  9. Clinical Database Server - Output • Dynamic queries (SQL) • Canned queries • Time span • Last "n" results • Class-based retrievals ("get all positive culture results")

  10. Medical Entities Dictionary (MED) • 56,000 medical concepts • 82,000 synonyms • Multiple hierarchy (72,000 links) • Semantic network (43,000 links) Calcium Preparations Intravascular Calcium Tests Abnormalities of Calcium Calcium Serum Calcium Plasma Calcium Hypercalcemia Hypocalcemia

  11. MED Server • Lexical searching • Concept attributes • Classes • Ancestors

  12. Web Server • Clinical database queries • Vocabulary server queries • Class queries • Translation • HTML document generation • Applets • Web links

  13. CPMC’s Web EMRs • Elpis - single patient view • PolyMed - service view • WebCIS - multiple views

  14. Web EMR Features • Frame-based interface • Summary reporting • Graphical displays • Multimedia displays • Cross-patient displays • Order entry • Integration of on-line resources • Security and confidentiality

  15. screen shots • alerts • cardiology - detail • ecg • multi-patient summary • lab order entry • pharmacy list • pharmacy rx • time view • patient list • departmental screen • headers - lab • details - lab • lab summary • lab graph • radiology - detail • dop - detail

  16. Integration of On-line Resources • Lab to Medline • Lab to PDR • Lab to disease description (DXplain) • Lab to differential diagnosis (DXplain) • Lab to guideline (cholesterol) • Drug to dietary restriction information • Drug to PDR • X-ray to Medline • X-ray to Web information sources

  17. screen shots of integration • Lab to disease description (DXplain) • Lab to differential diagnosis (DXplain) • Lab to guideline (cholesterol) • Drug to dietary restriction information • Drug to PDR • X-ray to Medline • X-ray to Web information sources

  18. Security and Confidentiality • User logon name and password • Encryption (SSL) • Logon screen ID (single use) • Session screen ID (expires)

  19. Current Challenges • Application development • Navigation of hypertext • No control over client machines • Resource integration • Hospital mergers

  20. parting shot - carmen sandiego lab