14. Hospital Information System

- Dr. Dilip Bhale

Introduction:

                 “Hospital Information System (HIS)” is a system that manages information in a hospital; that is collects, stores, analyses and makes the information available, when needed, to the right person. A hospital information system need not always be a computer-based system; it can be a paper based information system that has been used in hospitals for many years. However when we talk of an HIS we are referring to an information system that uses modern information and communication technologies, although we don’t say so explicitly.

Elaborate definitions of HIS have been given. One of the definitions considers the functions of an HIS:

“The goal of an HIS is to use computers and communication equipment to collect, store, process, retrieve and communicate patient care and administrative information for all hospital affiliated activities and to satisfy the functional requirements of all authorized users.”

Another slightly technology oriented definition is:

“An information system for the benefit of a hospital, in which data are coherently stored in a database, from where they are put at the disposal of authorized users at the place and at the time the data are required, in a format adapted to the specific needs of the user.”

Benefits of an HIS:

The benefits of a modern HIS over the conventional system are:

• Increase the effectiveness and productivity of health professionals
• Improve the quality of service
• Reduce the costs of service
• Improve levels of service and patient satisfaction

The above benefits will not always be the direct effect of deploying an HIS but will vary from system to system depending on the type of organisation and method of implementation.

Components of an HIS:

A hospital is a complex organisation so a hospital information system will also be a complex system catering to different users with different needs and functions.

A typical hospital information system will have different components performing entirely different functions but working in coordination with other components of the system.

•       Patient management: Patient registration, demographic data, appointments, scheduling, bed allotment etc. A computer based ‘Master Patient Index’ or ‘MPI’ is used to store patient identification information, demographic data collecting during patient registration and simple encounter level information like date and time of consultation etc. Another module conventionally used is called ‘Admission-discharge-transfer’ or ‘ADT’ module which, as the name implies, manages admission, discharge and transfer of a patient from one bed to another .

•       Departmental management: Individual departmental systems like laboratory, imaging, pharmacy, operation theatre etc. These systems can access the main hospital system particularly the MPI for patient specific data and results are made available to clinicians in a report format.

•       Clinical care: The ‘Electronic Patient Record’, EPR, is at the center of clinical care. Another module that is conventionally used in clinical care is called ‘Order-entry’ and ‘Results-reporting’. The EPR manages patient related clinical data like examination findings, diagnosis and treatment. Ancillary departmental data like results of tests forms a large part of any patient record so the clinician can view the results of tests for any patient under his care.

•       Clinical decision support: Decision support can be in the form of alerts, reminders or suggestions for a particular test or treatment for a patient. A Decision support system can alert the clinician about doses of medicines for a particular patient, allergies or drug interactions. Many organisations have developed ‘Clinical pathways’ for some conditions that identify clinical goals, interventions and expected outcomes by time period. A DSS can help the clinician to compare actual and expected outcomes and suggest intervention if a significant unexpected event occurs.

•       Financial and resource management: Administrative systems were, and still are, one of one of the first systems implemented in hospitals. The main functions of an administrative system are charge capture, accounting, personnel management and payroll. The system also aggregates data for short-term and long-term management of a hospital.

 Technical architecture of an HIS:

The technical architecture of hospital information systems has evolved with developments in information and communication technologies. First HISs were developed in the sixties and three different architectures have been used from the early to the modern HISs.

•      Monolithic systems: It was a central system developed to meet all the information needs of a hospital. These systems could integrate and communicate data well because they had a single data store and a common method to access information. They however required large initial investments were difficult to install and maintain.

•       Modular systems: Appearance of mini computers and then the personal computer led to individual departmental systems that could be implemented with low initial investment. These individual systems, modules, were connected to each other resulting in a comprehensive hospital wide system. The main problem with these systems was integration of different modules and full integration could never be achieved in practice.

•       Distributed systems: The new HISs use the new network-communication technology. A distributed system is a federation of independent computers connected to each other that share data, programs and resources like printers. Information is exchanged over a local or wide area network using standard communication protocols. Almost all the current HISs that are in use and available commercially support distributed architecture.

Standards and protocols in an HIS:

A clinician need not know the details of standards and protocols used in an HIS still if he knows the names of these things he will be at ease while talking to an IT person.

• Client Server architecture: A big powerful computer is the server and it is connected to many smaller less powerful computers, the clients. The database, application logic and user interface are the three components of a Client Server model and these reside on different computers.

• Intranet: Intranet is a local network that uses internet protocols particularly TCP/IP and browser interface

• TCP/IP: Transmission Control Protocol/Internet Protocol, a communication protocol.

• CORBA/ActiveX: Communication standards for system integration so that one system can talk to another.

• SQL: Structured Query Language, for communication with the database

• HL-7: Health Level – 7, A protocol used for internal communication.

• EDIFACT: Electronic Data Interchange for Administration, Commerce and Transport, for communication with systems outside the organisation.

• DICOM: Digital Imaging and Communications in Medicine, used for image management.

 Future HISs:

           The future hospitals are likely to be parts of ‘Integrated Delivery Networks’. The IDNs will comprise of primary care centers, specialist consultations, secondary care hospitals, tertiary hospitals and community health services.

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