Information Systems in Medicine Associated professor Semenets A.V. semenets@tdmu.edu.te.ua Department of Medical Informatics I.Ya.Horbachevsky Ternopil State Medical University

Main Questions Information Systems Basics. Medicine-Related Information Systems

1. Information Systems Basics Information systems (IS) definition Information technology (IT) definition IS and Related Disciplines IS types

1.1. Information system definition (A) An Information System (IS) is the system of persons, data records and activities that process the data and information in a given organization, including manual processes or automated processes; (Wikipedia, 2007.) The computer-based information systems is only the Information technologies component of an Information System; The computer-based information systems are the field of study for Information technologies (IT)

1.1. Information system definition (B) An Information System (IS) is any combination of information technology and people's activities that support operations, management and decision making. In a very broad sense, the term information system is frequently used to refer to the interaction between people, processes, data and technology. In this sense, the term is used to refer not only to the information and communication technology (ICT) that an organization uses, but also to the way in which people interact with this technology in support of business processes; (Wikipedia, 2012.)

1.2. Information technology (IT) Information technology (IT) is the study, design, development, implementation, support or management of computer-based information systems, particularly software applications and computer hardware. Information Technology Association of America (ITAA). IT deals with the usage of the computers hardware and software to convert, store, protect, process, transmit and retrieve information, securely.

1.3. IS and related disciplines Information Systems is a scientific field of study that addresses the range of strategic, managerial and operational activities involved in the gathering, processing, storing, distributing and use of information, and its associated technologies, in society and organizations. An IS is not only the technology that an organization uses, but also the way in which the organizations interact with the technology and the way in which the technology works with the organization’s business processes.

1.3. IS and related disciplines

1.4. Types of the IS A four level pyramid model of different types of Information Systems based on the different levels of hierarchy in an organization

1.4. Types of the IS A Transaction Processing System (TPSs) is a IS that collect, store, modify, and retrieve the transactions of an organization. A transaction is an event that generates or modifies data that is eventually stored in an information system. The essence of a transaction program is that it manages data that must be left in a consistent state, e.g. if an electronic payment is made, the amount must be both withdrawn from one account and added to the other; it cannot complete only one of those steps. Either both must occur, or neither.

1.4. Types of the IS A Management Information System (MIS) provides information that is needed to manage organizations efficiently and effectively. It are not only computer systems - these systems encompass three primary components: technology, people (individuals, groups, or organizations), and data/information for decision making. MIS are distinct from other information systems in that they are designed to be used to analyze and facilitate strategic and operational activities in the organization.

1.4. Types of the IS A Decision Support System (DSS) is a computer-based information system that supports business or organizational decision-making activities. DSSs serve the management, operations, and planning levels of an organization and help to make decisions, which may be rapidly changing and not easily specified in advance. DSS can be either fully computerized, human or a combination of both.

1.4. Types of the IS An Executive Information System (EIS) is a type of management information system intended to facilitate and support the information and decision-making needs of senior executives by providing easy access to both internal and external information relevant to meeting the strategic goals of the organization. It is commonly considered as a specialized form of decision support system (DSS).

1.4. Types of the IS

2. Medicine-Related Information Systems Hospital Information System Radiology Information System Laboratory information system Laboratory information management system Picture archiving and communication system

2.1. Hospital Information System A hospital information system (HIS), variously also called clinical information system (CIS) is a comprehensive, integrated IS designed to manage the administrative, financial and clinical aspects of a hospital. This encompasses paper-based information processing as well as data processing machines.

2.1. Hospital Information System One doctor’s clinic…. …one patient’s notes

2.1. Hospital Information System The aim of an HIS is to achieve the best possible support of patient care and administration by electronic data processing: more efficient use of the restricted resources available for patient care; qualitative improvement of the service to the patient; support of research; support of teaching;

2.1. Hospital Information System CISs are sometimes separated from HISs in that the former concentrate on patient-related and clinical-state-related data (electronic patient record) whereas the latter keeps track of administrative issues. The distinction is not always clear and there is contradictory evidence against a consistent use of both terms.

2.1. Hospital Information System Computer systems in clinical departments are generally can be used for the following tasks: Administrative support - the administrative and logistic planning of patient care and interventions. Patient data collection - the acquisition, storage, and retrieval of patient data, examinations, biosignals, and images; the real-time reduction and verification and the coding and processing of patient data; and the integration of all patient data into one comprehensive presentation. Decisions. Simulation of interventions by using models, the support of diagnostic and therapeutic decision making. Monitoring. The monitoring and assessment of therapy (drug therapy). Reporting. Generation of reports, for example, after the discharge of the patient from the hospital or when referring patients to other clinicians. Assessment. Evaluation of the effect of the care that was provided on patient outcome.

2.1. Hospital Information System Bellow shown general stages in the HIS evolution: Isolated Applications Monolithic Systems Evolutionary Systems Composable Systems

2.1. Hospital Information System

2.1. Hospital Information System HIS can be composed of one or a few software components with specialty-specific extensions as well as of a large variety of sub-systems in medical specialties (e.g. Laboratory Information System, Radiology Information System).

2.1. Hospital Information System

2.1. Hospital Information System There are three types of integration can be distinguished: Data integration - means that data registered in one application are available to another application, if necessary and provided that it is not conflicting with confidentiality. This prevents repeated recording of the same data and reduces the risk of mistakes . Presentation integration implies that data from various applications are presented to the user in an adequate and consistent way. Especially for dynamically changing data, this is not self-evident. Functional integration means that functions of different applications are available to the qualified user within one user environment

2.1. Hospital Information System

2.1. Hospital Information System Sample patient record view from an image-based electronic health record (VistA).

2.2. Laboratory information system A lab information system (LIS), is a class of software which handles receiving, processing and storing information generated by medical laboratory processes. These systems often must interface with instruments and other information systems such as hospital information systems (HIS).

2.2. Laboratory information system Basic common features of the LIS: Patient Check In Order Entry Specimen Processing Result(s) Entry Reporting Patient Demographics Physician Demographics.

2.2 Laboratory information system An LIS is a highly configurable application which is customized to facilitate a wide variety of laboratory workflow models. Disciplines of laboratory science supported by LIS' include: hematology, chemistry, immunology, blood bank (Donor and Transfusion Management), surgical pathology, anatomical pathology, flow cytometry and microbiology.

2.2 Laboratory information system

2.3. Laboratory information management system A "Laboratory Information Management System" (LIMS) is computer software that is used in the laboratory for the management of samples, laboratory users, instruments, standards and other laboratory functions such as invoicing, plate management, and work flow automation. The difference between LIMS and LIS that primary are generally targeted toward environmental, research or commercial analysis, such as pharmaceutical or petrochemical, and second are targeted toward the clinical market (hospitals and other clinical labs).

2.3. Laboratory information management system

2.3. Laboratory information management system The goal of implementation the LIMS is to create a seamless organization where: Instruments used are integrated in the lab network; receive instructions and worklists from the LIMS and return finished results including raw data back to a central repository where the LIMS can update relevant information to external systems such as a Manufacturing Execution System or Enterprise Resource Planning application.

2.3. Laboratory information management system The goal of implementation the LIMS is to create a seamless organization where: Lab personnel will perform calculations, documentation and review results using online information from connected instruments, reference databases and other resources using electronic lab notebooks (ELN's) connected to the LIMS.

2.3. Laboratory information management system The goal of implementation the LIMS is to create a seamless organization where: Management can supervise the lab process, react to bottlenecks in workflow and ensure regulatory demands. External participants (department, etc.) can place work requests and follow up on progress, review results and print out analysis certificates and other documentation.

2.3. Laboratory information management system

2.4. Radiology IS A Radiology Information System (RIS) is used by radiology departments to store, manipulate and distribute patient radiological data and imagery. Basic Features of RIS: Patient Registration; Patient Scanning; Result(s) Entry; Reporting; Result(s) Delivery including faxing and e-mailing of clinical reports; Patient Tracking;

2.4. Radiology IS - pathwork

2.4. Radiology IS - example

2.4. Radiology IS vs. PACS

2.5. Picture archiving and communication system In medical imaging, picture archiving and communication systems (PACS) are computers or networks dedicated to the storage, retrieval, distribution and presentation of images. The medical images are stored in an independent format. The most common format for image storage is DICOM (Digital Imaging and Communications in Medicine).

2.5. Picture archiving and communication system A PACS allows to store volumic exams and to reconstruct 3D images

2.5. Picture archiving and communication system PACS replaces hard-copy based means of managing medical images, such as film archives. It expands on the possibilities of such conventional systems by providing capabilities of off-site viewing and reporting (distance education, telemedical uses). Additionally, it enables practitioners at various physical locations to access the same information simultaneously (telemedical uses).

2.5. Picture archiving and communication system The most difficult area for PACS is interpreting the DICOM image format. A feature common to most PACS is to read the metadata from all the images into a central database. This allows the PACS user to retrieve all images with a common feature no matter the originating instrument. The differences between vendors' DICOM implementations make this a difficult task.

2.5. Picture archiving and communication system A full PACS should provide a single point of access for images and their associated data (i.e. it should support multiple modalities). It should also interface with existing hospital information systems: Hospital information system (HIS) and Radiology Information System (RIS).

2.5. Picture archiving and communication system

Conclusion In this lecture was described next questions: Information Systems Basics. Medicine-Related Information Systems

References Wikipedia, the free encyclopedia www.wikipedia.org Hospital Information Systems (HIS) Information Technology Directory http://www.health-infosys-dir.com Healthinformatics: http://healthinformatics.wikispaces.com/