Additional Health Information Systems 8 Additional Health Information Systems

Pretest (True/False) During clinical drug trials, phase II testing is performed on patients for whom the treatment is intended. A transplant is a device intentionally put into the body to serve a particular purpose.

Pretest (True/False) (continued) The ER typically has ready access to a patient’s records in the HIM department. Speech recognition software can be taught to avoid past mistakes. A glucose monitor is an example of an instrument that facilitates point-of-care testing.

Departmental Information Systems HIS is core system for hospital: Includes both clinical and administrative systems Consists of complex arrangement of multiple individual systems Practice management system is principal system for medical office

EHR Interface Health records originate from many separate systems: Records imported into EHR Records imported into central CDR Records only retrieved and displayed from EHR; stored on own respective systems

Why Multiple Information Systems? IT department may follow two different approaches to information systems: Integrated systems approach uses systems from one vendor Best-of-breed approach chooses software based on departmental needs

Why Multiple Information Systems? (continued) Certain hospital departments may have more influence and select their own software Some equipment may come with own software required for operation CAT scan, MRIs, PET, biomedical devices

Patient Registration System Demographic information about patient Guarantor and insurance information used for billing Some clinical data (admitting and discharge diagnosis, LOS, and organ donor, DNR, consent, other forms) Patient’s medical record number

Figure 8-1 Patient registration screen Figure 8-1 Patient registration screen. (Courtesy of McKesson Corporation.)

Master Patient Index (MPI) Includes all previously registered patients Contained in special database (large healthcare organization) or patient registration database (smaller facility) Prevents duplicate entry of same patient Provides quick universal lookup of patients for all systems interfaced to the HIS

Master Patient Index (MPI) (continued) Helps locate patient chart (paper-based system) Often includes Soundex field to facilitate finding surnames when name’s spelling unclear

Figure 8-2 Master patient index. (Courtesy of McKesson Corporation.)

Laboratory Information System (LIS) Receives orders and sends results of medical tests performed by lab Receives information directly from automated lab instruments via electronic interface Sends information about equipment to LIS

Laboratory Information System (LIS) (continued) Uses HL7 interface standard to connect with HIS, CPOE, EHR, other healthcare systems

Workflow of Electronic Lab Orders Some clinical pathology tests performed with automated instruments receive orders from LIS; send results back to LIS Anatomic pathology findings and nonautomated clinical pathology tests entered manually LIS generates printed or faxed lab report; also sends to EHR if interfaced

Workflow of Electronic Lab Orders (continued) Digital pathology captures specimen images digitally, displays on computer monitor; images stored on PAC system

Figure 8-5 Workflow of electronic lab orders and results.

Radiology Information System (RIS) Manages workflow in radiology departments Communicates with PAC systems Schedules and tracks radiologic studies Posts charges Communicates with other systems such as HIS, EHR, billing

Examples of Images Digital x-ray images Computed radiography (CR) Digital radiography (DR) Computerized axial tomography (CAT) Magnetic resonance imaging (MRI) Positron emission tomography (PET)

Dictation/Transcription Systems Based on provider’s dictation, which may be recorded on microcassette tapes, digital voice files, or via telephone Typed by transcriptionists using special equipment and word processor Reviewed by provider for accuracy, then corrected as needed by transcriptionist

How Speech Recognition Software Works Noise-canceling microphone sends speaker’s word sounds to computer, which converts into digital data Software uses mathematical calculations to identify phonemes in digital data and compare to “language model” Software then groups phonemes correctly into words displayed on screen as if keyed

How Speech Recognition Software Works (continued) Errors may be corrected by user; software stores for future reference

Pharmacy Systems Comprised of one or more computer systems for tracking, ordering, dispensing medications Interfaced with registration, billing, CPOE, EHR systems

Pharmacy Systems (continued) Include decision support, patient medication administration reports, controlled substance tracking, intervention documentation, inventory control, pricing, purchasing, repackaging, distribution

Emergency Department System Considerations ER may use different software system than rest of hospital ER may not have access to patient’s records (HIM or physician office) ER patients may be unconscious and unidentified Allergies or medical history information may be unknown

Emergency Department System Considerations (continued) Some patients without primary care physician may treat ER as walk-in clinic

Perioperative Software Records all aspects of presurgery, surgery, postsurgical recovery Includes nonpatient functions such as management and scheduling of operating rooms, surgical supplies, equipment, personnel May include software for anesthesiologist

Implants and Transplants Implants: device or substance intentionally put into the body to serve particular purpose Examples: heart valves, pacemakers, breast implants, artificial joints Transplants: organ or tissue from human donor Examples: kidney, heart, liver, bone marrow

Implant Registry Data Facilitates study of performance and longevity of implants Includes adverse events resulting from implant Includes patient demographic data, facility, implant manufacturer, implant identification information

Transplant Registry Data Tracks potential recipients and includes clinical data about patient status and condition Includes information on donors, such as cause of death, medical history, medications, procurement process, consent forms

Transplant Registry Data (continued) Communicates with international registries like UNOS and NMDP Includes post-transplant records on recipient and on living donors

Clinical Trial Phases Phase I: Small groups of subjects tested in controlled setting to see if drug is safe, tolerated by healthy person Phase II: Testing performed on patients for whom treatment intended; focuses on finding right dosage levels and proving drug works

Clinical Trial Phases (continued) Phase III: Large patient groups undergo controlled studies; some patients receive drug, others receive placebo Phase IV: Survey drug once approved and on market