1. Additional Health Information Systems8
Additional Health Information Systems

2. 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.

3. 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.

4. 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

5. 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

6. 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

7. 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

8. 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

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

10. 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

11. 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

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

13. 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

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

15. 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

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

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

18. 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

19. 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)

20. 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

21. 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

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

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

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

25. 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

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

27. 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

28. 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

29. 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

30. 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

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

32. 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

33. 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