د حاتم البيطار محاضر ادارة المستشفيات ومكافحة العدوى

1. Summary of Health Information Systems By Dr Hatem El Bitar

2. Health Information Systems Architectures and Strategies Strategic Information Management in Hospitals 2 2

3. Architectures of Hospital Information Systems Introduction After having introduced health information systems in general we will at first turn our attention to hospital information systems We now take a closer look at what hospital information systems look like. We will do that rather synthetically, meaning: – we will first look at all the detailed components a hospital information system consists of, – and then we will explain how these components can be synthesized, i.e. assembled in order to achieve that what users nowadays experience as the hospital information system 3 3

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5. Architectures of Hospital Information Systems We start discussing the kind of data, which has to be processed in hospitals and then present hospital functions interpreting or updating these data We introduce typical information processing tools and typical architectures first at the logical and then at the physical tool layer of hospital information systems. At each layer we explain how these tools can be assembled and integrated for the better support of users 5 5

6. Architectures of Hospital Information Systems After this lecture, you should be able to answer the following questions: – – – – – What kind of data has to be processed in hospitals? What are the main hospital functions? What are the typical information processing tools in hospitals? What are the different architectures of HIS? How can integrity and integration be achieved within HIS? 6 6

7. Architectures of Hospital Information Systems Domain Layer: data to be processed in Hospital Entity types related to Patient Care (examples) Typical entity types representing certain object classes and data related to the patient and his or her histories: Entity type Descriptor of an instance of the represented object class Case mostly comprises a patient‟s stay in a hospital from patient admission to patient discharge or several ambulatory treatments related to one disease; information about a case includes the case identification number (CIN Patient is a person being subject of care; information about a patient includes the patient identification number (PIN) Order is a request for a diagnostic, therapeutic or drug service, e. g., a laboratory order or a radiological order Diagnosis is the identified cause or nature of a disease or medical condition Note: we can express „kind of data‟ by entity types 7 7

8. Architectures of Hospital Information Systems Entity types related to Resources (examples) A hospital must guarantee that all resources needed for patient care are available continuously. The following resources are necessary: Entity type Descriptor of an instance of the represented object class Appointment determines what persons have to be at a certain place at a given time. Examples are appointment for patient admission, examination or surgery. Bed must be managed according to its occupation. Health care professional a health care professional who treats according to his or her specialization (e. g. nephrology or pediatrics) patients with certain diagnoses. Health care professionals are for example physicians and nurses. Drug is a substance administered to a patient for treatment, diagnosis or prevention 8 8

9. Architectures of Hospital Information Systems Entity types related to Administration (examples) Besides information about resources, hospital administration needs the following entity type: Entity type Descriptor of an instance of the represented object class Patient record archive describes how and where the electronic or paper-based patient record can be found. Classification consists of a set of classes summarizing concepts not to be distinguished during analysis. Classification of diagnoses e. g. the International Classification of Diseases (ICD). Cost unit information about a person or an institution responsible for bearing the costs or a part of the costs for the services to be provided 9 9

10. Architectures of Hospital Information Systems Entity types related to Management (examples) Management relates to the hospital as a whole and, thus, needs compressed information about the hospitals‟ operating. The following entity types are necessary for management: Entity type Descriptor of an instance of the represented object class Business strategy defines the hospital‟s long-term strategic goals Strategic information management plan a strategic plan, which gives directives for the construction and development of a hospital information system Project a unique undertaking that is characterized by management by objectives, by restrictions with regard to available time and resources, and by a specific project organization (DIN 69901) Quality report openly published report about a hospital‟s performance 10 10

11. Architectures of Hospital Information Systems Domain layer: Hospital Functions We will now elucidate, how and where data about these entity types are processed in hospitals. We use enterprise functions to summarize classes of information processing activities. And since we focus on hospitals, we call them hospital functions here, which can also be considered as representatives of processes 11 11

12. Architectures of Hospital Information Systems We will present hospital functions and their interpreted and updated entity types in greater detail, but we do not (yet) focus on how they are typically supported by various computer-based or non-computer-based information processing tools We will focus on the following questions: – – – What are the main hospital functions that have to be supported by a HIS? What information is interpreted or updated by hospital functions? Which functional aspects have to be considered when implementing information processing tools? 12 12

13. Architectures of Hospital Information Systems Main enterprise function to be supported by a HIS: – – – – – Patient care Supply and disposal management, scheduling and resource allocation Hospital administration Hospital management Research and education 13 13

14. Architectures of Hospital Information Systems Patient care: – – – – – – Patient admission Decision making, planning and organization of patient treatment Order entry Execution of diacnostic, therapeutic and nursing procedures Coding of diagnoses and procedures Patient discharge 14 14

15. Architectures of Hospital Information Systems Patient admission: Patient admission (short: admission) aims at recording and distributing the patient demographics and insurance data as well as medical and nursing data of the patient history In addition, each patient must becorrectly identified, and a unique patient and case identifier must be assigned 15 15

16. Architectures of Hospital Information Systems Patient admission This hospital function can be decomposed as follows: – – – – – – Appointment scheduling Patient identification and checking for recurrent Administrative admission Medical admission Nursing admission Visitor and information service 16

17. Architectures of Hospital Information Systems Apointment scheduling: The hospital must be able to schedule an appointment for a patient's visit. In addition, unplanned patient admissions must be possible (e.g., in case of emergencies) 17

18. Architectures of Hospital Information Systems Patient identification and checking for recurrent: A unique patient identification number (PIN) must be assigned to each patient: – This PIN should be valid and unchangeable lifelong (i.e., the PIN should not be based on changeable patient‟s attributes such as the name) The PIN is the main precondition for a patient-oriented combination of all information arising during previous, recent as well as future hospitalizations – Before a PIN can be assigned, the patient must be correctly identified, usually based on a health insurance card and on available administrative patient master information (such as name, date of birth) ….. 18 18

19. Architectures of Hospital Information Systems If the patient has already been in the hospital, she or he must be identified as recurrent, and previously documented information must be made available (such as previous diagnoses and therapies). If the patient is in the hospital for the first time, a new PIN must be assigned. In addition, the hospital must be able to distinguish different cases or hospital stays of a patient. Therefore, in addition to the PIN, a case identification number (CIN) is usually assigned (see administrative admission). 19

20. Architectures of Hospital Information Systems Administrative admission: Administrative admission starts following patient identification. It creates a so- called case, being the aggregation of several contacts, clustered according to specific clinical and/or organizational purposes of the hospital In case of inpatient treatment, a case summarizes the hospital stay from patient admission until discharge Each case is uniquely identified by its CIN. Important administrative data such as insurance data, details about special services, patient's relatives, admitting physician, and transfer diagnoses must be recorded ….. 20

21. Architectures of Hospital Information Systems Some of the administrative data must be available to other hospital functions through the help of certain organization media. Administrative data form the backbone of information processing In case of changes, patient data must be maintained and communicated. If the admitting physician has communicated relevant information (e.g., previous laboratory findings), this information must be communicated to the responsible physician in the hospital ….. 21

22. Architectures of Hospital Information Systems Administrative admission is usually done either in a central patient admission area or directly on the ward (e.g., during emergencies or on the weekend) Even in emergencies patient admission is necessary. At least patient identification and checking for recurrent has to be performed in order to assign a proper PIN and CIN. In these cases a short version of administrative admission may be applicable If the patient is unconscious and does not bear an identity card, only a dummy name may be recorded to provide PIN and CIN. It will be no problem to replace the dummy name by the correct name later 22 22

23. Architectures of Hospital Information Systems Medical admission: The responsible physician will carry out the medical admission. This typically comprises the patient history (disease history, systems review, social history, past medical history, family history, medication). Some of this information may be collected from documents of the referring physician and is taken to the hospital by the patient himself. Medical admission is usually done on the ward As a result of medical admission the admission diagnosis has to be stated and to be coded according to ICD10 The basic patient history data have to be made available for other hospital functions. For the patient history there may also be department-specific, (semi-) standardized data entry forms available The collected information should be available during the whole stay 23 23

24. Architectures of Hospital Information Systems Nursing admission: The responsible nurse will proceed with the nursing admission. This typically comprises the introduction of the patient to the ward and the nursing history. Nursing admission is usually done at the ward Administrative data and the reason of hospitalization are already at her or his disposal For the nursing history there may be computer-based or department-specific, (semi-) standardized data entry forms available. These may contain information about the current diagnosis and therapy, orientation, communication ability, social contacts, nutrition, mobility, personal hygiene, and vital signs The collected information should be available during the whole stay 24 24

25. Architectures of Hospital Information Systems Visitor and information services: The hospital management must always have an overview of the recent bed occupation, i.e., about the patients’ staying at the hospital. This is, for example, important for the clerks at the information desk, who must be able to inform relatives and visitors correctly, and also for some general hospital management statistics 25 25

26. Architectures of Hospital Information Systems Patient admission . Extract of the domain layer of the 3LGM² based reference model describing the enterprise function patient admission, its subfunctions and interpreted and updated entity types. 26 26

27. Architectures of Hospital Information Systems Patient care: – – – – – – Patient admission Decision making, planning and organization of patient treatment Order entry Execution of diacnostic, therapeutic and nursing procedures Coding of diagnoses and procedures Patient discharge 27 27