Hospitals Information System - Essay Example

My Hospital’s Information System Hospitals in essence deal with healthcare, attending to sick and infirm, prescribing treatments for alleviating suffering, reducing morbidity, preventing death, and effecting cure. In the hospital environment an effective information system is like a network of nerves that interconnect medical departments, facilities, services and administration. The information system in a hospital are geared to serve two major roles (i) collection, collation, information generation related to the patients for decisions taking related to diagnosis, treatments, admissibility, logistics etc. and, (ii) information dissemination to patients about their treatment modules, scanning procedures, precautions, preventions, and costs of treatments. This essay discusses the usefulness of our hospital’s information system on our work as a nurse and on our clients, the patients. 1. Information Systems a. ‘Best of Breed’ Systems Over the last few decades the information technology has progressed by leaps and bounds. Along the technology has grown the number of IT solution providers, the large multinationals, medium and small, and those working in specialised niche areas. When selecting an IT product or application the big company is not necessarily the best. The wisdom instead lies in selecting a company which provide the best solution to a specific need, at a reasonable cost. The ‘best of breed’ approach is therefore a strategic approach to select the best product for each solution, from a variety of companies, instead of buying everything from one company. This approach invariably gives optimal solution in each area, richer functionality, and thus establishes business linkages with more companies. Our hospital therefore uses the ‘best of breed’ approach for development and functioning of its information system. The ‘best of breed’ approach is, however, beset with its own problems as compared to the approach of selecting integrated systems that provide multiple applications with a common database, integrated sharing, convenience, and consistent user interface. A comparison of the two approaches is worthwhile to find out the comparative value of the two approaches: (i) Cost: Specialized features of ‘Best of Breed’ applications provide competitive advantage which serve to cut costs and increase revenue. The systems’ advance features compensate for higher up-front and on-going costs as against the integrated systems which may have lower licensing costs, may not require costly interfaces, and overall may be less expensive. Shared data in integrated systems also reduces costs and increases scope for revenue by better decision taking. (ii) Leverage: The ‘Best of Breed’ approach keeps the hospital in a position to bargain with the vendor because there are several alternatives, and due to this the vendor maintains continuous relationship with the hospital. In case of integrated systems, once the installation is over the relationship is significantly diminished. When the need for adding a new module arises, due to the lack of choice from other vendors, the supplier of integrated systems offers limited or no scope for negotiation for the terms and cost. At this stage a decision for replacing of the integrated system will be very expensive, as compared to the ‘Best of Breed’ where it will be less expensive to replace just part of it and upgrade it. (iii) Human Resource: Integrated system, due to their compatibility all along the enterprise, has the advantage of lower required expenditure for recruitment of staff and their training. In ‘Best of Breed’ situation the IT staff must be trained to use and support multiple systems possibly using different hardware platforms, operating systems, databases, and programming languages. This situation demands a variety of expertise and skills, and increased training costs. (iv) Support: While in integrated system there is one vendor to blame, in case of a trouble with the ‘Best of Breed’ vendor of one system blames the other for the overall systems functionality. It is easier to deal with one vendor of integrated system than many representing different systems. (v) Data Sharing: Many integrated systems on offer are in fact interfaced ‘Best of Breed’ systems of small companies acquired by large companies. Such systems may be using different platforms, databases, operating systems, and may pose problems. Truly integrated systems developed by one company are advantageous. However, the use of data exchange standards like HL7 in healthcare will allow sharing of data in ‘Best of Breed ‘ environment very effectively. (vi) Functionality: The ‘Best of Breed’ systems are considered most advantageous, as compared to integrated systems, when the system’s richer functionality is the most desired objective. As is evident from the above analysis it is more a matter of choice, need, and the cost that play a role in selecting the integrated system or the ‘Best of Breed” systems for an information system. b. Meditech & UHealth Systems The systems deployed in our hospital are Meditech and UHealth. Both these systems are highly advanced and fulfil the need of the hospital which has over twenty nine key medical services, in addition to other services. The hospital has a strong Quality and Patient Safety policy and Code of Conduct which together aim at high degree of professionalism and reducing errors in hospital care. Both the information systems greatly help in achieving the above objectives by easing information on workflow across the hospital. A brief description of Meditech and UHealth is covered below: (i) Meditech: It is a Healthcare Information System (HIS) developed by the Massachusetts based Medical Information Technology Inc. (MEDITECH,). Meditech is software designed to capture, store and display administrative and clinical data in a hospital environment or medical practice. It is commonly used by hospitals of all sizes to provide well integrated applications. Some broad functions that it caters to are: Administrative: Applications used to register, admit, schedule appointments, and manage Medical Records. Clinical: Applications are used by clinical staff to order, manage, document and report clinical test results, and physician’s orders. Patient Care or Advance Clinics: Applications that are used by nurses and doctors to document treatments and to view Electronic Medical Records (EMR). Patient Financials/Revenue Cycles: Applications bill insurance send statements. General Financials: Applications used to manage hospital’s financial business. Decision Support: Applications for hospital managements and administration with consolidated information to manage departments and hospitals. Continuing Care: Applications for non-acute care, long-term care, behavioural health, home services, and services tailored to specific needs. Technical: Are system wide functionality like report writer, system management, administration and control functions. Meditech is used by nurses, doctors and various departments like pharmacy, radiology, diagnostic laboratories, etc. to enter their data in the system. Nurses carry out their assessment, documentation and other functions using this system. Doctors also enter their patients’ data through this health information system. (ii) UHealth: This is the University of Miami Health System which aims to deliver leading-edge patient care by the region’s best doctors. The UHealth combines patient care, research, and education to create a front-line approach in health care. Within the UHealth system, patients can participate in clinical trials and benefit from the latest developments that are fast-tracked from the laboratory to the bedside. UHealth’s comprehensive network includes several hospitals, outpatient facilities. By using the system the hospital is linked with the hospital systems in the USA. Under this system any interested client can seek information about the hospital, facilities and its services. International patients can have a healthcare coordinator who will take care of all aspects of treatment. The system allows coordination of care with all specialities and facilities, financial services and logistics services. The information system is divided between the hospital and clinics. c. Systems Interface: The systems deploy the use of Health Level Seven (HL7), which is a comprehensive framework for providing standards for the exchange, integration, sharing, and retrieval of electronic health information. HL7 provides standards for interoperability that improve healthcare delivery, optimize workflow, reduce ambiguity and enhance knowledge transfer among stakeholders, including healthcare providers, government agencies, the vendor community, and patients. HL7 processes exhibit timeliness, scientific rigor and technical expertise without compromising transparency, accountability, practicality, and aim to put the needs of stakeholders first. The organisation responsible for development and promotion of HL7 is the Health Level Seven International (HL7, 2012). The HL7 standards define format for the transmission of health-related information, which may relate to clinical practice and management, delivery and evaluation of health services. Under this standard, information is sent as a collection of one or more messages, each of which transmits one record or item of health-related information. Examples of HL7 messages include patient records, laboratory records and billing information. HL7 and their messages are currently used widely, but many systems may not understand the messages. Therefore, HL7 interface engines are used to work alongside the existing applications as an interpreter, speaking the language of HL7. At the hospital the interface allows complete integration of information for use by the nurse in the nursing process. 2. Information Security & Patients’ Privacy Measures Information security and patient’s privacy are governed by institutional policy and regulations. The entire information system is required to meet some basic level security measures to protect the integrity of data and networks. In addition some systems, computers and network need additional security measures and are given enhanced level of protection. A general classification of security measures covers the following approaches: (i) Basic security: It is baseline level of security for all devises and systems. (ii) Enhanced security: Servers and computers designated for storing private or legally or contractually protected data need enhanced security. (iii) Security under Health Insurance Portability and Accountability Act (HIPAA) of 1996: Components falling under jurisdiction of HIPPA must comply with the requirements of the Act. Any sharing of HIPPA governed information must be approved by HIPPA compliance office. The hospital applies several types of security measures to protect its data. One approach is domain authentication of every user who is given a unique address in the database. For this the user needs a user name and a password to access his account and the data. The other process used is data encryption, which is the conversion of data into a form called cipher text which cannot be easily understood by unauthorised people. Opposite to encryption is the process of decryption which involves conversion of encrypted data back to its original form. Encryption is achieved by using encryption software; some softwares encrypt only specific files or folders while others encrypt the entire hard disk. While undertaking encryption it is important to identify as to where store the encrypted data and its keys. The encrypted software must be from reputed firms otherwise they act a backdoor for hackers, spywares etc. and are risk to data safety. There are different options for encryption for different operating systems like Windows, Macintosh, Unix, USB flash drives. 3. Systems Support to Nursing The WHO (2000) exemplifies the steps that nurses are required to pursue for providing care; those steps involved in nursing process are the foundation of clinical decision making. The Meditech management information system used in our hospital has taken care of all the needs of nursing process steps given below: (i) Nursing assessment – Nurses carry out their assessment using Meditech by systematic and on-going feeding of pertinent data relating to the patient; the data are collected using appropriate assessment techniques. The data include physical, psychological, social, cultural, spiritual, cognitive, functional abilities, developmental, economic, and lifestyle, and it is easily retrievable. (ii) Problem identification or diagnosis – Inbuilt systems allow analysis of the collected assessment data in identifying the patient’s problems/diagnoses, needs, and resources. Diagnoses are documented in a manner that facilitates the determination of expected outcomes and plan of care. Expected outcomes are individualized to the patient and documented, as measurable goals, and this provides direction for continuity of care. (iii) Planning - a plan of care that prescribes interventions is achieved by establishing linkages between diagnoses, interventions, and outcomes. The plan is individualized to the patient and priorities set for care reflecting current practice. (iv) Outcome identification – based on diagnosis, the expected outcomes are individualized to the patient, and time estimates are made for attainment. Expected outcome provide direction for continuity of care, and are documented as measurable goals to be reached and evaluated. (v) Implementation - identifies interventions of medication, surgeries, replacements etc. and is put into action, and the interventions are documented in the Meditech in a timely manner. (vi) Evaluation - the accuracy of diagnoses and effectiveness of the interventions are evaluated in relationship to the patient’s progress; actual outcomes are determined. The effectiveness of interventions is documented in Meditech in relation to the attainment of the outcomes. Whenever a medication is given in the hospital, it is documented in electronic medication administration record (eMAR) of the patient. The eMAR technology is part of the hospital’s core pharmacy information system where all aspects about a patient’s medication orders are recorded. The critical components of this safety technology are bar coded armbands, bar coded medications, and safety checks within the eMAR and Bar Coding software. Under this system, on admission a patient receives an armband with a bar code. The bar code corresponds to the patients current medical record, including drug history, allergies and lab results. Bar code identifiers also appear on shrink-wrapped doses of medication. Before a medication is administered, bar codes on the patient armband and the medication are scanned allowing the nurse or therapist to verify that the right patient is receiving the right drug in the right dose at the right time. The software checks each medication against the patients drug history and lab results. If conflicts or potential drug interactions are identified, warnings alert the nurse to double check, verify and/or call the doctor before administering the medication. The technology has resulted in reduction of medication errors through use of bar code identifiers on the patient armband and medication. This also makes patient care information readily available to nursing staff during medication administration like critical values and comprehensive allergy and drug interaction information. Besides it provides physicians with a comprehensive list of patient medication use. .Ammenwerth (2011) demonstrated that quality of information processing in nursing significantly improves following the introduction of computerised systems. The improvements are reflected by completeness of nursing documentation, better overview of patient, improved readability and reduction of duplicated documentation, better workflow, and compliance of legal regulations. Using Meditech it is easily achieved because of the ease of the system, which has been developed to pursue the goals of hospital’s quality policy and patients safety. Use of computerised information systems have greatly eased healthcare, and this is demonstrated at our hospital. While at the hospital level the information systems help in driving patient flow, providing all necessary logistic support and treatment facilities, the information system helps the nurses in discharge of their duties meticulously. Besides the systems also greatly help the nurse in coordinating with other divisions, facilities, and providing necessary information to the patients. 4. Prospects for the future A report published earlier (Jha, A.K., DesRoches, C.M., Campbell, E.G., Donelan, K., Rao, S.R., Ferris, T.G., et. Al, 2009) has shown very low levels of adoption of electronic health records in U.S. hospitals . The study suggests that policymakers in the US face substantial obstacles to the achievement of health care performance goals that depend on health information technology. It suggested a policy strategy focused on financial support, interoperability, and training of technical support staff to spur adoption of electronic-records systems in U.S. hospitals. The electronic medical records (EMR) use is governed by regulations which every healthcare provider is bound to follow. Under the Health Information Technology for Economic and Clinical Health (HITECH) section of the American Recovery and Reinvestment Act (ARRA) of 2009, compliance of the meaningful use (MU) of information technology entitles care providers some benefits. And the Health Insurance Portability and Accountability Act (HIPAA) of 1996 provides for the protection of patient medical records. Therefore, the priority for our hospital will be to comply with the requirements of both the Acts. Under HIPPA the deadline for transition from ICD-9 to ICD-10 encoding for hospital inpatient treatment is October, 2013. Standards to be issued under HIPPA will also need to be complied with. Another development for the future is Computerized Physician Order Entry (CPOE) which will lead to full use Computerized Order Entry (COE) throughout the hospital leading to improvement in clinical diagnostic capabilities, quality, patient safety and clinical workflow processes. The hospital is therefore expected to work in these directions and become fully compliant and competitive. References: Ammenwerth, E., Rauchegger, F., Ehlers, F., Hirsch, B., Schaubmay, C. (2011) Effect of a nursing information system on the quality of information processing in nursing: An evaluation study using the HIS-monitor instrument. International Journal of Medical Informatics. 80, 25-38. Jha, A.K., DesRoches, C.M., Campbell, E.G., Donelan, K., Rao, S.R., Ferris, T.G., Shields, A., Rosenbaum, S., Blumenthal, D (2009). Use of electronic health records in US hospitals. The New England Journal of Medicine. 360, 1628-1638. Health Level Seven International (2012). http://www.hl7.org/about/index.cfm?ref=nav MEDITECH (December, 2012). https://www.meditech.com/newmeditech/homepage.htm WHO (December, 2000). Building standard-based nursing information systems. Division of Health Systems Development, Organization and Management of Health Systems and Services, Human Resource Development, Pan American Health Organization, Washington, D.C. Read More