INFORMATICS 2003

8/6/2019 INFORMATICS 2003

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INTRODUCTON TO

HOSPITAL

INFORMATIN SYSTEMS


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DEFINITION AND PURPOSE OF

HOSPITAL INFORMATION SYSTEMS

What is a Hospital Information System? What is it

for?

A Hospital Information System (HIS) is a

computerized system designed to meet the

information needs of all (or most) of a

hospital. This includes many diverse types of

data, such as: Patient information

Clinical laboratory, radiology, and patient

monitoring


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Patient census and billing

Staffing and scheduling

Outcomes assessment and quality control

Pharmacy ordering, prescription handling,

and pharmacopoeia information

Decision support

Finance and accounting

Supplies, inventory, maintenance, and

orders management


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ADVANTAGES OF HOSPITAL

INFORMATION SYSTEMSWhat's so great about them? A 1992 survey of

executive nurses (Simpson 1992) listed these

benefits:

Increased time nurses spend with patients

Access to information

Improved quality of documentation

Improved quality of patient care

Increased nursing productivity

Improved communications


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Reduced errors of omission

Reduced medication errors

Reduced hospital costs Increased nurse job satisfaction

Compliance with regulations of the Joint

Commission on Accreditation of Health CareOrganizations (JCAHO)

Development of a common clinical database

Improved patient's perception of care Enhanced ability to track patient's record

Enhanced ability to recruit and retain staff

Improved hospital image


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But what about the cost? Here are some

interesting estimates:

It costs approximately $5,000 to

computerize a nursing administrative

office

Administrative uses of Hospital

Information Systems can save

approximately $36 billion each year inthe U.S.

(Estimates from Saba &

McCormick1996, p.308)


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DEVELOPMENT AND FUTURE OF

HOSPITAL INFORMATION SYSTEMS

Early hospital computer systems

developed from business computing

systems in the late 1950s and early1960s, and were used for accounting,

billing, inventory and similar business-

related functions. Others were developed during the 1960s

primarily for storing patient information

to be used by medical staff.


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These types of systems have been slow

to integrate. Surveys (Dorenfest 1987,1992) of hospitals since 1980 have shown

that less than half

ofcommunityhospitals have full HospitalInformation Systems, mainly because few

were available to integrate all the

functions

needed. Research and teaching hospitals

presumably have a much higher usage of

Hospital Information Systems.


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The future is not certain. Several factors are

at work:

Computer hardware is getting moreaffordable

Computer software is notgetting any less

expensive

Budgets for Hospital Information Systems

are generally notexpanding

Medical caregivers are under pressure to

handle more patients on an outpatient

basis, reducing hospital census and

generally reducing hospital budgets


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Standards for storing and exchanging

patient information have notbeenagreed on

An overall plan for national health

care - which could have a big impacton Hospital Information Systems -

has been a political football, leading

to uncertainty in planning.


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TYPES OF HOSPITAL INFORMATION

SYSTEM

Hospital Information Systems come inmany flavors, depending on whether

they are based on...

centralized or decentralized plans

software that was originally business-

oriented or patient-oriented

terminals or workstations


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Centralized vs. Decentralized

This distinction is based on whether information iskept primarily in a central computer, or isdistributed over a number of workstations orservers located around the hospital.

There are variations on this; for example, a system

may be partially centralized but integrated withpowerful and somewhat independent satellitesystems. Examples:

Some systems may centralized certain functions like

billing and accounting in an administrative facilityserving several affiliated hospitals, while otherfunctions like patient record-keeping are carried outat the individual hospitals or medical units.


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Other systems may centralize their

patient record-keeping and have smooth

exchange of information with a

specialized clinical laboratory computer

system which is mainly independent of

the primary HIS.


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Business Oriented vs. Patient Oriented

Though both these types of systemshandle patient information, the

orientation of the original designers may

affect the procedures and general"character" of a HIS.


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Terminal vs. Workstation Oriented

Terminals and workstations are computer

devices that often look very similar: bothusually have a keyboard and a CRT displayscreen, and are often confused with oneanother. What's the difference?Terminals are

electronic devices that let humanscommunicate with a computer. They aregenerally connected to minicomputers ormainframes, which could be close by orhalfway around the world. They may havesome minor processing power of their own,but are generally not able to do anything if notattached to a (functioning) computer.


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Workstations are computers designed for

professional use by one person at a time. They

are fully functional computers on their own,but they can be networked to other

workstations, mainframes, or minicomputers.

(T

he term workstation can refer to anypersonal computer, but is often applied to

specially powerful microcomputers.)


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Terminal-oriented systems are by nature very

centralized, since the terminal can't do

anything on their own. Workstation-orientedsystems can be either centralized or

decentralized, because the processing power

of the workstation gives system designers a lotof flexibility.

The trend in most types of computer work is

toward decentralization, but this trend is

somewhat slower in hospitals because of the

high risks associated with failure in hospitlas

and the consequent reluctance to change

systems that are working now.


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Still, workstation-oriented systems offer a numberof advantages over terminal-oriented ones:

Greater flexibility: information can be eithercentralized or decentralized.

Workstations are much more independent: theycan function to some degree even when a centralsystem is "down".

Since they are used by only one person at once,workstations don't slow down when lots ofpeople are using the system (except when theyare requesting information from a central

database). Workstations let people do many kinds of work,

including word processing and generalcalculation, which are not practical on terminal-based systems.


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How Hospital Information Systems

Are Organized

Here are diagrams of some of the possibleconfigurations discussed above. Of course,

these are only a representative sampling.

Symbols used in these diagrams:


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Fully centralized system:


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Centralized with access to a parallel system in

clinical lab and radiology:


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Workstation oriented with centralized patient

records:


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Fully distributed with workstations:


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How do these different systems affect

you? All give you complete access to all

relevant data

Parallel system in lab/radiology getsresults faster

Workstations provide more features than

terminals

Distributed systems are often more

reliable than centralized ones


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Nursing Informatics: What It Is And

How It Impacts Hospital Caregivers

What is Nursing Informatics; Who isInvolved?

Nursing Informatics is the systematic

application of nursing science tocomputer systems, in order to provide

clinical information in the most

convenient form. Nursing Informaticsprovides a conceptual framework for

studying the type of information needed

in nursing.


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Nurses may specialize in

informatics, taking jobs with titlessuch as:

nursing informatics (orinformation) specialist

nursing systems analyst

computer nurse

systems nurse


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The need for Nursing Informatics

Nursing Informatics arose from therealization that nobody can providethe exact information needed by

nurses, except the nursesthemselves. Physicians have theirown perspective on what is needed;computer scientists are involved inthe technical details of computersystems.


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Impact ofNursing Informatics

In hospitals, nursing informatics

specialists serve to:Channel informationfrom caregivers to computer systems

designers

Help select computer equipment suitableto nursing needs

Educate computer staff about medical

matters

Educate medical caregivers about

computer systems


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Nursing informatics plays a larger

role on the national and international

level:

The American Nurses Association (ANA)

is working to develop nursing datastandards through its ANA Database

Steering Committee.

Several nursing organizations are workingto define a standard "Computer Patient

Record" (unfortunately known as a

CPR...)


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Specialists are developing ways of classifying

and computerizing aspects of nursing such as:

Nursing intervention lexicon and taxonomy Effectiveness of patient care

Internationally accepted vocabulary for

describing medical and nursing matters

Classification of nursing practice Several

specialists are studying ideal ways for

information to flow from one point to anotherin the hospital environment

Other specialists are studying the best ways to

computerize nursing mgt. and education.


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Where is Nursing Informatics Used?

Nursing informatics specialists provide

planning and guidance in creatingcomputer systems for:Nursing

administration

Nursing practice

Critical care

Outcomes and guidelines

Community health nursing

Nursing education

Nursing research


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Patient Documentation Systems

From the perspective of the medicalcaregiver, Hospital Information Systems

are tools for storing and retrieving

patient information. What information iskept in these systems?Basic patient

information (name, address ...)

Diagnostic information Physicians' orders

Medication data


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Diet information

Event reports

Nursing notes

Billable procedures; suppliesconsumed

Care plans

Discharge plans

Case management information


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Getting Computer Access Where It

Needs To Be In Hospitals

When medical caregivers work with HospitalInformation Systems, what is the most

convenient and efficient place to give them

access to it? For most inpatient settings, thereare usually three locations available:

1. By the patient's bed

2. In the hall close to the patient's bed

3. In a staff-only area such as the nursing

station or ward office


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1. By the patient's bed

Bedside placement is

necessary for monitoring systems

and intervention control devices likeinfusion pumps. For documentation

of patient condition, however, there

is no advantage to this.


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A study (Marr et al.1993) found that

reporting did not improve when

nurses had bedside access to the HIS,since most of their note were

entered either outside patients'

rooms, or in the rooms of other

patients. However, putting HIS access

by the bedside did improve the useof computerized patient care plans,

calculation of patient acuity, and

billing for nursing services.


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In the hall

Hallway placement of HIS access appearsto be gaining popularity. It allows nurses to do

their documentation very soon after leaving

the patient's bedside, without the distractionof having the patient present, possibly

demanding attention. There is a security risk

in the hall, as unauthorized individuals maygain information about a patient's condition

by peering over the nurse's shoulder.


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Other possibilities

"Electronic clipboards" (similar to

the devices used by delivery companies

such as United Parcel Service and Federal

Express) have great promise in making it

easier to enter reports in a timely

manner. One possible disadvantage:

"Whose room did I leave thatconfounded clipboard in this time?!?"

W ki ith H it l I f ti


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Working with Hospital Information

SystemsWhat are the most important things

a Hospital Information System does for

nurses? Here's what 340 nursing

administrators said, when surveyed in

1992 (Simpson, 1992):Order entry

Integrate care plans with charting

functions Prepared patient care plans

Track medication administration

Discharge planning


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Patient acuity list

Cost tracking and reporting Electronic mail to other departments

Graphical display of patient data

Automated medical record

Bedside capability (but only 29% said

they had this)

Case management of critical pathways


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Documents

INFORMATICS 2003