Health (hospital)Information Systems

Dr. László Daragó PhDAssociate professor

Semmelweis UniversityHealth Informatics Institute

The Healthcare and the Information System

3

The functions of the hospital

• Medical Care– Diagnostics– Therapy

• Nursing

• Hotel services

4

The function of the HIS (Hospital Information System)

• It supports – Daily routine (input, output (work lists))– Managing (queries)– Decision making (reports)

5

I/O, query, report

input output

parameter outputquery

outputreport

6

The Hungarian Health care

Health care

Primary care Care

Outparient’s care Inpatient’s care

Basic level

High-level

Active care

Chronic care

7

Finance

Health care

Primary careCapitation

CarePerformance based

Outpatient’s care Inpatient’s care

Basic levelItemised (German score)

High-levelItemised vs. normative

Active careNormative (DRG’s)

Chronic careItemised (Daily fee)

8

Structure of HIS

Return Case

Departmental case Event

Resource (Direct-) Costs

Hospital case Hospital (indirect) costs

9

Functional architecture of HIS

Clinical subsystem/module• Outpatient’s care• Inpatient’s care• Order communication• Pharmacy• Catering• Lab• Imaging•…

Economical subsystem/module• General ledger• Personnel• Waging• Logistics• Hotel services• Technical supports• Security•…

Admission/discharge/transfer (ADT) subsystem/module

10

Module vs. subsystem

• Information system (Top-Down)– Database (well defined: MBDS based)– User surfaces (by several type of users)

• Communication system (Bottom-Up)– User tailored systems (subsystems)– Communication interfaces

• Distributed/integrated database

Management information system

12

MIS

• Integrated or interfaced "user-machine" system for servicing information to support the operation, managing and decision support in a given organisation.

• That is:– Connected to an organisation– End-user system included– Services information

• It supports – Operation (daily routine)– Managing– Controlling– Decision support

13

IS, MIS, MISS, HIS, EIS, DSS

SP/EIS

TP

OP & C

MISS

DSS

MIS/ISHIS

14

MIS

• Strategic planning: – Goals, policy and general procedures at a given life

cycle of the organisation.

• Management control and tactical planning:– Source, input and output tactics, developments,

budget planning and monitoring.

• Operational planning and controlling:– Accessing the optimal efficacy, efficiency and

economical way in the given circumstances.

• Transactional system: I/O, Query, Report

15

MIS

• HW, SW component (EDP: electric data processing)

• Human procedures, automations

• Models for analysis, planning, controlling and decision support

• Well defined database

System definition: the requirement’s document

17

The requirement’s document contains

Functional requirements

The user’s expectations on the services, should be performed.

Non functional requirements

Restrictions and constraints of the performing

-product restrictions

-organisational restrictions

-external (third party) restrictions

Domain requirements

Professional requirements, what must be performed independently of the aim of the provider or customer.

18

The types of the requirement’s documentation

User’s requirementsFree of contradictions,complete

SystemrequirementsFree of contradictions,complete

Software requirementspecifications •Determines only external behaviour•Specifies any restrictions that can preventa succesfull implementation•Must be easily updated•It can be used as reference for IS maintenance•It should contain forecast for the lifecycles of the IS•Whenever possible predicts and offers solutions for unwanted events

User Provider

User demands

User’s vision on the system:

Incomplete, full of contradictions

Systemproducer (IT)

correspondence

contract

Data handling

20

Goals of data handling

- To support the health protection, conserve the health status.

- To help the medical activity of the health service provider.

- Tracking the health status of the patient.- In interest of arrangements in public health or epidemic affairs.

- Data processing for statistical goals (depersonalisation)- Scientific research (Personal data must not be referred)- Data handling of Social Security.- Data handling for criminal, judicial, national security reasons.

21

Entities

External InternalExternal-external external-internaloutgoing report(work list) archivesincoming dictation(sheets)

Output: Stored: Form (screen), report (paper/screen), filefile, sound, multimedia, e-mail, etc.

Input:Form (sheet with formatted/unformatted text), file, image, sound, video, etc.

22

• Patient: closing report, medical report, prescription, assigning, letter of advice• Health insurance: performance based financing

– outpatient-– inpatient-

• GP: closing report, medical report • Medical college: defined by the professions• Health government: epidemic reports• Office of Statistics: statistical report• Office of Tax: tax reports (VAT: Value Added Tax, PIT: Personal Income Tax)• Ministry of Labour: reports on employment, report on employ• State Treasury: waging• Medical Technical Institute: state of instrumentality, probate• Owner/supporter: property, performance, trusted tools• Other hospital: data related on a transfered patient (see data security).

External-external output

23

External data transfer(simplified scheme)

hospital

Patent

Health insurance Health gov. Tax office

Medical college

Treasury

Med. tech. office Other hospital

GP

Owner/supporter

Stat. officeMin. of Labour

24

External-internal output• Administrative admission (personal, social, insurance data)

(ADT: Admission, Discharge, Transfer) • Medical admission (anamnesis, status, suspected diagnose, plan of

diagnostics)• Nursing diary (nursing status, plan for nursing, nursing decursus)• Temperature chart (medical status, plan for diagnostics and therapy,

decursus, consultation)• Medical history• Order communication

– diet– medicine– examination– procedure– transfer

25

Structure of hospital database

• General (basic) data of case– Personal data– Insurance data– ADT basic data

• Inpatient/outpatient financing data• Clinical data of case

– Medical data– Nursing data– Social data

Views of the HIS

27

HIS

• User– MD (memory support (patient, guideline), make

to document the case easy )

– Patient (inform, decision support)

• Organizer/Information Manager (conformance, user-friend solution, compliance with law and professional guidelines)

• Technician/Information Technology (robustness, reliability, maintenance, data security and safety)

28

HIS user

• External data supply– Minimum Basic Data Set (DRG’s)– Obligatory reports– Scientific research

• Worklists– Medical report– Prescription– Assigning (hospitalization)

29

HIS organizer

• Requirements

• Solution

• Application

• Training

• Hot line

• Help desk

30

HIS IT

• Hardware– Intelligent/dumb terminal– Network– Printing

• Software– Operating system– Applications, frame system– Internet

31

HIStory

• General ledger

• Accounting, inventory (materials, technical support, catering)

• Controlling

• Patient-statistics

• Performance based financial reporting

32

Dataflow diagram

patient

Input personal data

Scheduling

scheduled patient

patient

Open caseanamnesis

Make diagnosticplan

Execute diagnosticplan

Make therapy plan

Execute therapyplan

Evaluate

Nursing

status

diagnosticprocedure order

status

decursus

status

decursus

diagnose

therapy order

therapy

closing report

33

Basic entity of the cure,Minimum Basic Data Set (MBDS)

ADT:Admission, Discharge, Transfer

Medical caseIn/outpatient

Financial case

Patient

event

ExaminationProcedureTherapyDietTransportationConsultation

34

35

That’s All Folks!