498 PHCL DR. FATIMAH ALI ALROWIBAH Various Types of Health Information Systems

Objectives:  Health Information Systems Definition and Scope.  Key functions of HIS.  Component of hospital information system.  Limitations of paper records and drawback.  Electronic health Record.  Electronic medical record.  Electronic Medical Record adoption model HIMSS.  Successful EMR system implementations in Saudi Arabia.  Barrier to EMR implementation in Saudi Arabia.  Personal Health Record PHR and Purpose of PHR.

Health Information Systems Health Information Systems Definition: Lindberg, a pioneer in medical information systems, defined them as: “the set of formal arrangements by which the facts concerning the health or the health care of individual patients are stored and processed in computers.” In other words, HIS is a type of information system that uses computers, communication equipment and applications to collect, store, process, retrieve and communicate patient care and administrative information to improve health care management.

HIS Scope Departmental: a system limited to a specific clinic (e.g. Respiratory therapy) Interdepartmental: a system that primarily serves one department but shares information and functions with other departments (e.g. Laboratory, patient scheduling) Hospital-wide: a system that focuses on the integration of various departmental systems. Enterprise-wide: a system that can include all departmental systems including hospitals, clinics, nursing homes and other health facilities. External: a system that is shared among different health systems and primarily exists to report information required by regulatory or government agencies.

The health information system Key functions of HIS : data generation, compilation, analysis,synthesis, communication and use. The health information system collects data from the health sector and other relevant sectors,analyses the data and ensures their overall quality, relevance and timeliness, and converts data into information for health-related decision- making.

Hospital Information System Components Main Components Core applications: patient scheduling and admission, discharge and transfer (ADT) which provides the central notification to the hospital of patient visits.This serves as the central database for many other applications. *Business and financial systems such as patient accounting and billing as well as payroll for employees. *Communications and networking applications that transmit and manage messages between departments to help track patient data.

Others : Departmental systems such as pharmacy, radiology and laboratory which are designed to manage clinical operations. Documentation systems which are used to capture data (e.g. Speech recognition transcription) Reminder and advice functions to assist physicians (CDSS) (e.g. Messages when drug-drug interactions may occur during prescription, significant lab results are found).

Clinical departmental System

Health care information system

What is wrong with this picture?

Disadvantages of Paper Recode Illegible handwriting Incomplete data. Data fragmentation- each lab report is a separate piece of paper which does not allow a physician to visualize patient progress. Poor availability- studies have shown that as much as 40% of the time the paper record can not be found. Insecure in open, unguarded shelving in a clinic. When it comes time to share the record with another clinician, each individual piece of paper has to be copied & mailed. Employee cost of moving all this paper around More space for medical office

Paper Record Drawbacks Limitations of paper records include: As a physical entity, the paper record is found in a single location for a single use and is restricted to one user at a time. There is no way to check if data is missing or if there are inconsistencies in paper records. (i.e. errors in data entry) The data cannot be rearranged for display in different ways that might help the physician notice new issues. Physician & nurse time spent on paperwork Privacy risks: no audit trail of access.

Patient Record This is the principle repository for information concerning as specific patient’s healthcare Over time, it helps show the progression of health issues for the patient individually. (e.g. Includes past results and progress)

Electronic Health Record Advances in IT have helped the patient record to move from paper-based only to hybrid paper and electronic format and to fully electronic format. Reasons to transition from paper to EHR include: Patient safety Improve patient care Control costs Provide better public health supervision. Other terms are Electronic Medical Record, Computer-based (patient record (CPR

Electronic Health Record (EHR) Broadly defined as: Arecord for all types of care —to prevent illness —maintained over a long time period accessible to caregivers and the patient. There are many variations of the definition based on the standards such as: An electronic record of health-related information of an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization. OR: A CPR is electronically maintained information about an individual’s lifetime health status and health care.It replaces the paper medical record as primary source of information for health care meeting all clinical, legal, and administrative requirements.

Different Concepts Compared

EHR Summary It is not an object, or a product, but a set of systems that must interact to support clinical workflow and related processes. It is not possible to buy a medical record system as a product on the market: it is a subsystem of systems. Are not massive databases, but independent computer systems at individual care sites, which – with appropriate security – access specific data from any system. Provide availability to complete and accurate patient data, clinical reminders and alerts, decision support, and links to bodies of related data and knowledge-bases * Facilitate the capture, storage, processing communication, security, and presentation of health information.

CPOE Computerized physician order entry (CPOE) is defined by (HIMSS) as an "order entry application specifically designed to assist clinical practitioners in creating and managing medical orders for patient services and medications". It is an electronic medical record technology that allows physicians to enter orders, medications, or procedures directly into the computer instead of handwriting them. CPOE systems are becoming integral additions to electronic health records. Studies show that CPOE use can reduce medication errors and treatment orders, along with errors that often come when misreading providers’ handwriting. The system transmits the order to the appropriate department or individual so the order can be carried out. The most advanced implementations of such systems also provide real- time clinical decision support (CDSS) such as dosage and alternative medication suggestions, duplicate therapy warnings, and drug-drug interaction checking.

EMR -HIMSS

Successful EMR system implementations in Saudi Arabia EMR systems were introduced in 1988 in Saudi Arabia. Saudi hospital first in the Middle East to achieve global recognition for its healthcare IT. KFSH-RS :The KFSH & RC hospital in Riyadh has almost fully implemented an EMR system,and is reported to have the latest IT. HIMSS Analytics Asia announced King Faisal Specialist Hospital & Research Center (KFSH&RC) in Riyadh and Jeddah, Saudi Arabia, has achieved Stage 6 on the Electronic Medical Record Adoption Model (EMRAM). *King Faisal Specialist Hospital & Research Center ranked in top 5% worldwide for safety, quality of care and efficiency in new global rating by HIMSS Analytics Asia

Successful EMR system implementations in Saudi Arabia…cont At KFSH-RS clinical applications which have been shown to improve quality and safety, such as: * Computerized Practitioner Order Entry (CPOE) where physicians enter patient orders directly into the clinical information system which interacts with an intelligent clinical decision support system. * Physician Documentation supported by clinical decision support. *Closed Loop Medication Administration with the use of bar codes to verify the right medication for the right patient at the right time in the right strength. *Nursing Documentation online with some direct medical device connectivity for physiologic vital sign capturing.

Successful EMR system implementations in Saudi Arabia…cont King Khaled Eye Specialist Hospital Achieves HIMSS Analytics Electronic Medical Records Adoption Model (EMRAM) Stage 6 Award It is the first Saudi Ministry of Health hospital to achieve the internationally recognized benchmark.

Successful EMR system implementations in Saudi Arabia…cont The NGHA has four hospitals and 60 primary and secondary healthcare centers. The four hospitals are located in four different cities; Riyadh,Jeddah, Dammam and Al-hsa. At All four NGHA hospitals have EMR systems that are integrated with each other.

Successful EMR system implementations in Saudi Arabia…cont :The Armed Forces hospitals There are five Armed Forces hospitals under the Saudi Ministry of Defense and Aviation and all five hospitals have a fully implemented and integrated EMR system.In 2007, the first system was implemented and was operational in the north-western region of Tabuk Armed Forces hospital.

EMR- Middle East

Stage 7 means the hospital is a paperless and digital hospital.

BARRIERS TO EMR IMPLEMENTATION IN SAUDI ARABIA Resource barriers. Technical barrier. Social barriers.

PHR Benefits of Personal Health Records * For consumers, the patient can access to a wide array of credible health information, data, and knowledge to improve their health * Patients with chronic illnesses will be able to track their diseases in conjunction with their providers, promoting earlier interventions when they encounter a deviation or problem. * Improved communication will make it easier for patients and caregivers to ask questions, to set up appointments, to request refills and referrals, and to report problems.

Definitions and Characteristics of a Personal Health Record: “An electronic application through which individuals can access, manage and share their health information, and that of others for whom they are authorized, in a private, secure, and confidential environment

Purpose of PHR In particular, consumers place value on easy access to test results and better communication with clinicians Patients who are more engaged in their health are more active participants in the therapeutic alliance, for example, when patients with chronic conditions collaboratively manage their illnesses with clinicians to reduce pain, improve functional outcomes, and improve medication adherence

References PROGRESS AND CHALLENGES IN THE IMPLEMENTATION OF ELECTRONICMEDICAL RECORDS INSAUDIARABIA: A SYSTEMATIC REVIEW,Rihab Hasanain1, Kirsten Vallmuur2 and Michele Clark,Health Informatics- An International Journal (HIIJ) Vol.3, No.2, May 2014