Hospital Information Systems (HIS)

Strategic Information Management in Hospitals

copyright by

Dr. Zeinab Adam Mustafa, PhD, M. Sc

Biomedical Engineering Department
Sudan University of Sciences & Technology

Email: zenab42000@yahoo.com

Hospital Information Systems 1

Health Information Systems

Introduction

After this lecture, you should be able to answer the following questions:

– What are the HIS, MIS and HMS?

– What are transinstitutional health information systems?
– What are challenges for health information systems?
– What are electronic health records?

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What is wrong with this picture

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What is wrong with this picture
• Illegible handwriting, Ambiguous and
incomplete data, Data fragmentation- each
lab report is a separate piece of paper which
does not allow a physician to visualize the
progress of a patient’s conditions.
• Poor availability- studies have shown that as
much as 40% of the time the paper record can
not be found.
.
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 What is wrong with this picture

• When it comes time to share the record with another

clinician, each individual piece of paper has to be
hand copied, then mailed.
It can cost a clinic up to … just to do this
• Employee cost of moving all this paper around –
estimates it costs… just to pull one chart.
• Space – most medical office space rents for …

HIS Comes to found the solutions to all of that and

even more.
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MIS , HMS, and HIS Main goals

• The goal of a HIS is to sufficiently enable the adequate

execution of hospital functions for patient care,
including patient administration, taking into account
economic hospital management as well as legal (e.g.
data protection or reimbursement aspects) and other
requirements
• When the HIS goal focusing on the medical systems
inside the hospital it may called Medical Information
System (MIS).
• When the HIS goal is focusing on Managing the
Hospital as general is called Hospital Management 6
System (HMS)
MIS Parts

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HMS Parts

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HIS Management Features

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 The Tasks of HIS

To support patient care and the associated administration, the tasks of hospital
information systems are:

– to make information, primarily about patients, available: current information

should be provided on time, at the right location, to authorized staff, in an
appropriate and usable form

• for this purpose, data must be correctly collected, stored, processed, and
systematically documented
• to ensure that correct, pertinent, and up-to-date patient information can be
supplied, for instance, to the physician or a nurse

– to make knowledge, (e.g. about diseases, about side effects, and interactions of
medications) available to support diagnostics and therapy

– to make information about the quality of patient care and the performance and
cost situation within the hospital available 10
Health Information Systems

A health care professional accessing patient information

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 HIS Areas in side The Hospital

Hospital information systems have to consider various areas of a hospital,

such as:

– Wards and outpatient units

– Service units: diagnostic (e.g., laboratory department, radiology department),

therapeutic (e.g., operation room) and others (e.g., pharmacy, patient records
archive, library, blood bank)

– Hospital administration areas (e.g., patient administration department, patient

record archive, department of quality management, financial and controlling
department, department of facility management, information management
department, general administration department, human resources department)

– Offices and writing services for (clinical) report writing

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HIS Areas in side The Hospital

Hospital information systems have to consider various areas of a hospital,

such as:

In addition there are:

– Management areas such as hospital management, management of clinical and

non-clinical departments, administration management, and nursing
management)

These areas are related to patient care. They could be broken down
further. For university medical centers, additional areas, needed for
research and education, must be added to the above list

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HIS Requirements

HIS must consider all groups of persons:

– Patients and, in certain respect, their visitors.

– The most important groups of people working in a hospital are
– Physicians, and nurses,
– Administrative and technical staff
– Medical informaticians and health information management staff

Within each group of people, different needs and demands on the hospital
information system may exist, depending on the role, tasks and responsibilities.

For example ward physicians require different information than physicians working
in service units or than senior physicians. Patients sometimes need similar
information as physicians but in different form

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HIS Requirements

Hospital information systems make available:

– the right information and knowledge

– at the right time
– at the right place
– to the right people
– in the right form,

so that these people can make the right decisions, this is also described as
information and knowledge logistics

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Transinstitutional Health Information
Systems
Transinstitutional health information systems

In many countries, the driving force for health care and for ICT in health
care has recently been the trend toward: a better coordination of care,
combined with rising cost pressure

One consequence is the shift toward better integrated and shared care

This means that the focus changes from isolated procedures in one
health care institution (e.g. one hospital or one general practice) to the
patient-oriented care process, encompassing diagnosis and therapy,
spreading over institutional boundaries

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Transinstitutional Health Information
Systems
Transinstitutional health information systems

A group of two or more legally separated health care institutions that

have temporarily and voluntarily joined together to achieve a common
purpose are defined as health care network

The information system of a health care network is called a

transinstitutional health information system

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Transinstitutional Health Information
Systems
Transinstitutional health
information systems

A general practitioner accessing documents of a hospital information system

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Transinstitutional Health Information
Systems
Typical examples:

Regional health information systems, comprising the health care environment

in a certain region, including e.g. hospitals, offices of general practitioners,
pharmacies, rehabilitation centers, home care organizations and even health
insurances and governmental authorities

Health care institutions are merging into large integrated health care delivery
systems. These are systems of health care institutions that join together to
consolidate their roles, resources, and operations to deliver a coordinated
range of services and to enhance effectiveness and efficiency of patient care.

Hospitals as centers of care delivery change to decentralized networks of

health care delivery institutions that are called regional networks or health
care networks

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Transinstitutional Health Information
Systems
Hospital information systems will increasingly be linked with
information systems of other health care institutions (i.e. enterprise
boundaries are blurring)

The architecture of hospital information systems must take these

developments into account. They must be able to provide access or
to exchange patient-related and general data (e.g., about the
services offered in the hospital) across its institutional boundaries

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Transinstitutional Health Information
Systems
A lot of technical and legal issues have to be solved before computer-
supported transinstitutional health information systems will
adequately support trans-institutional patient care

– A general willingness to cooperate with other health care providers must exist;
optimal care processes must be defined, and recent business processes be
redesigned;
– Accounting and financing issues must be regulated;
– questions of data security and data confidentiality must be answered, together with
questions on data ownership (patient or institution) and on responsibilities for
distributed patient care;
– issues on long-term patient records (centralized or decentralized) must be
discussed;
– and technical means for integrated, trans-institutional information processing must
be offered (telemedicine, eHealth), including general communication standards

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Electronic Health Records

Electronic Health Records as a Part of Health Information

Systems

The most important enterprise functions in health care are related to

diagnostics and therapy. Obviously, data that are relevant to medical
decision making need to be collected and presented in a patient
record
– A patient record in general is composed of all data and documents generated or
received during the care of a patient at a health care institution.
– Nowadays, many documents in the paper-based patient record are computer
printouts, such as laboratory results, or discharge summaries typed into a text
processing system
– The portion of documents created in computer-based form will further increase
– It seems natural to strive for a patient record that is partly or completely stored on
electronic document carriers: the electronic health record (EHR)

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Electronic Health Records

The electronic health record (EHR) is the collection of medical data

relating to one subject of care, i.e. the patient, that are stored in the
computer-supported part of a health information system

The EHR for a subject of care might be scattered physically across

multiple (discrete or interconnected) clinical systems and repositories,
each of which will hold and manage a partial EHR for each of its data
subjects, scoped according to the service or community settings,
clinical domains and time periods of use of that system in the life of
each person

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Electronic Health Records

EHR used to be provider-centric, i.e. they only contained patient information that was
recorded in one institution, e.g. in a hospital or in a physician‟s office. Those EHR are
usually called electronic patient records (EPR)

Hence, potentially relevant information about the medical history of a patient that was
recorded in other institutions was missing or had to be recorded again. This led to
quality and efficiency problems

Although this situation can still be found in many institutions, efforts are being made
today to organize EHRs patient-centric, i.e. independent of institutional boundaries.

To achieve the vision of a complete and lifetime-spanning EHR which supports health
care on the one hand, but respects legal and ethical issues on the other hand,
different strategies can be found

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 Challenges for HIS

Challenges for Health Information Systems

In spite of the positive general development of health

information systems, challenges can be identified that have to
be resolved

Evolutionary grown information systems consist of a variety of

components and tend to be very heterogeneous

As a consequence, major challenges exist ….

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Challenges for HIS

Challenges of health Information systems:

– The challenge of user acceptance. Health care professionals have the

problem of having to use a set of application components, often with
different user interfaces, overlapping features and separate user
identification procedures. This is time-consuming and potentially
dangerous for the patient, as important data may not be available when
needed, leading to wrong diagnostic or therapeutic decisions

– The challenge of data redundancy. As different health care professionals

often need the same data, heterogeneous information systems typically
lead to data duplication: Relevant data may be documented several times
at different sites and or by different providers

– …..

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Challenges for HIS

– The challenge of transcription. In heterogeneous architectures

there is a considerable amount of transcription, i.e. the transfer of
data from one storage device to another (e.g., the transfer of a
patient‟s diagnoses from the patient record to an order entry
form).

– The challenge of maintaining referential integrity. For redundant

data, either as replicates or even as duplicates, it is difficult to
obtain and later maintain referential integrity, i.e. the correct
assignment of entities, for example the assignment of data to a
certain patient

– …..

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Challenges for HIS

– The challenge of costs. Too high, in particular uncontrolled

redundancy causes considerable additional maintenance costs
for updating replicate data in (redundant) databases

– The challenge of privacy and security. Patients‟ health data

belong to the most sensitive data about humans. For this reason
individual patient data must only be accessible to those persons
the patient authorized before

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Challenges for HIS

In transinstitutional health information systems, the problem of

heterogeneity can be estimated even higher. Since these systems
involve many originally autonomous information systems, some
additional challenges can be identified:

– The challenge of terminology. Having data stored in different databases

(and without a unique and comprehensive data model or data dictionary)
at different sites, there is no immediate need for a unified terminology and
semantics

– The challenge of transinstitutional information management. Nowadays in

many hospitals the operational, tactical and strategic information
management is organized professionally

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Summary
Information systems that are dealing with processing data, information and
knowledge in health care environments are called health information systems

Health information system can be differentiated in institutional health information

system, e.g. hospital information systems, and transinstitutional health information
systems that span the borders of two or more legally separated institutions

Transinstitutional health information systems play a vital role in supporting integrated

care

The electronic health record (EHR) is the collection of medical data relating to one
patient that is stored in the computer-supported part of a health information system.
EHRs are needed to support functions of patient care as well as for administrative
functions

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