1. Health (hospital) Information Systems Dr
Health (hospital) Information Systems Dr. László Daragó PhD Associate professor Semmelweis University Health Informatics Institute

2. The Healthcare and the Information System

3. The functions of the hospital
Medical Care
Diagnostics
Therapy
Nursing
Hotel services

4. The function of the HIS (Hospital Information System)
It supports
Daily routine (input, output (work lists))
Managing (queries)
Decision making (reports)

5. I/O, query, report
input
output
parameter
query
output
report
output

6. The Hungarian Health care

7. Finance

8. Structure of HIS Return Case Hospital case Hospital (indirect) costs
Departmental case
Event
Resource
(Direct-) Costs

9. Functional architecture of HIS
Admission/discharge/transfer (ADT) subsystem/module
Clinical subsystem/module
Outpatient’s care
Inpatient’s care
Order communication
Pharmacy
Catering
Lab
Imaging …
Economical subsystem/module
General ledger
Personnel
Waging
Logistics
Hotel services
Technical supports
Security …

10. Module vs. subsystem Information system (Top-Down)
Database (well defined: MBDS based)
User surfaces (by several type of users)
Communication system (Bottom-Up)
User tailored systems (subsystems)
Communication interfaces
Distributed/integrated database

11. Management information system

12. MIS
Integrated or interfaced "user-machine" system for servicing information to support the operation, managing and decision support in a given organisation.
That is:
Connected to an organisation
End-user system included
Services information
It supports
Operation (daily routine)
Managing
Controlling
Decision support

13. IS, MIS, MISS, HIS, EIS, DSS
SP/EIS
DSS TP
MIS/IS HIS
OP & C
MISS

14. MIS Strategic planning: Management control and tactical planning:
Goals, policy and general procedures at a given life cycle of the organisation.
Management control and tactical planning:
Source, input and output tactics, developments, budget planning and monitoring.
Operational planning and controlling:
Accessing the optimal efficacy, efficiency and economical way in the given circumstances.
Transactional system: I/O, Query, Report

15. MIS HW, SW component (EDP: electric data processing)
Human procedures, automations
Models for analysis, planning, controlling and decision support
Well defined database

16. System definition: the requirement’s document

17. The requirement’s document contains
Functional requirements
The user’s expectations on the services, should be performed.
Non functional requirements
Restrictions and constraints of the performing
-product restrictions
-organisational restrictions
-external (third party) restrictions
Domain requirements
Professional requirements, what must be performed independently of the aim of the provider or customer.

18. The types of the requirement’s documentation
User demands
User’s vision on the system:
Incomplete, full of contradictions
User’s requirements
Free of contradictions, complete
System requirements
Free of contradictions, complete
Software requirement specifications
Determines only external behaviour
Specifies any restrictions that can prevent a succesfull implementation
Must be easily updated
It can be used as reference for IS maintenance
It should contain forecast for the lifecycles of the IS
Whenever possible predicts and offers solutions for unwanted events
User
Provider
correspondence
contract
System producer (IT)

19. Data handling

20. Goals of data handling
To support the health protection, conserve the health status.
To help the medical activity of the health service provider.
Tracking the health status of the patient.
In interest of arrangements in public health or epidemic affairs.
- Data processing for statistical goals (depersonalisation)
- Scientific research (Personal data must not be referred)
- Data handling of Social Security.
Data handling for criminal, judicial, national security reasons.

21. Entities External Internal External-external external-internal
outgoing report
(work list) archives
incoming dictation
(sheets)
Output: Stored:
Form (screen), report (paper/screen), file
file, sound, multimedia, , etc.
Input:
Form (sheet with formatted/unformatted text),
file, image, sound, video, etc.

22. External-external output
Patient: closing report, medical report, prescription, assigning, letter of advice
Health insurance: performance based financing
outpatient-
inpatient-
GP: closing report, medical report
Medical college: defined by the professions
Health government: epidemic reports
Office of Statistics: statistical report
Office of Tax: tax reports (VAT: Value Added Tax, PIT: Personal Income Tax)
Ministry of Labour: reports on employment, report on employ
State Treasury: waging
Medical Technical Institute: state of instrumentality, probate
Owner/supporter: property, performance, trusted tools
Other hospital: data related on a transfered patient (see data security).

23. External data transfer (simplified scheme)
Min. of Labour
Stat. office
Health insurance
Health gov.
Tax office
Patent
Medical college
hospital GP
Treasury
Med. tech. office
Owner/supporter
Other hospital

24. External-internal output
Administrative admission (personal, social, insurance data) (ADT: Admission, Discharge, Transfer)
Medical admission (anamnesis, status, suspected diagnose, plan of diagnostics)
Nursing diary (nursing status, plan for nursing, nursing decursus)
Temperature chart (medical status, plan for diagnostics and therapy, decursus, consultation)
Medical history
Order communication
diet
medicine
examination
procedure
transfer

25. Structure of hospital database
General (basic) data of case
Personal data
Insurance data
ADT basic data
Inpatient/outpatient financing data
Clinical data of case
Medical data
Nursing data
Social data

26. Views of the HIS

27. HIS
User
MD (memory support (patient, guideline), make to document the case easy )
Patient (inform, decision support)
Organizer/Information Manager (conformance, user-friend solution, compliance with law and professional guidelines)
Technician/Information Technology (robustness, reliability, maintenance, data security and safety)

28. HIS user External data supply Worklists Minimum Basic Data Set (DRG’s)
Obligatory reports
Scientific research
Worklists
Medical report
Prescription
Assigning (hospitalization)

29. HIS organizer Requirements Solution Application Training Hot line
Help desk

30. HIS IT Hardware Software Intelligent/dumb terminal Network Printing
Operating system
Applications, frame system
Internet

31. HIStory General ledger
Accounting, inventory (materials, technical support, catering)
Controlling
Patient-statistics
Performance based financial reporting

32. Dataflow diagram patient Scheduling scheduled patient
Input personal data
Nursing
closing report
status
status
patient
decursus
anamnesis
Evaluate
Open case
decursus
therapy
status
Execute therapy plan
Make diagnostic plan
diagnostic procedure order
therapy order
diagnose
Execute diagnostic plan
Make therapy plan

33. Basic entity of the cure, Minimum Basic Data Set (MBDS)
Patient
ADT:
Admission, Discharge, Transfer
Financial case
Medical case
In/outpatient
Examination
Procedure
Therapy
Diet
Transportation
Consultation
event

35. That’s All Folks!