Hospital Information System. Its types, Architecture, Forms or layers. Recent trends in HIS.

1. Information Systems in
Health Care
Babitha K Devu, RN, RM, M.Sc (N), MBA
Assistant Professor, SMVD College of Nursing, J & K
Research Scholar, Ph.D (N), Amity University, Gurugram

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INTRODUCTION
• A health information system (HIS) refers to a system designed to manage
healthcare data.
• This includes systems that collect, store, manage and transmit a patient’s
electronic medical record (EMR), a hospital’s operational management or a
system supporting healthcare policy decisions.
• Health information systems also include those systems that handle data related
to the activities of providers and health organizations.
• As an integrated effort, these may be leveraged to improve patient outcomes,
inform research, and influence policy-making and decision-making.
• Because health information systems commonly access, process, or maintain
large volumes of sensitive data, security is a primary concern.

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DEFINITIONS
• Health Care Information System (HCIS) are powerful ICT-based tools able to
make health care delivery more effective and efficient. (Rodrigues, 2010)
• HCISs is a synergy of three other discipline, namely health care management,
organization management, and information management. (Tan 2005)
• HCISs comprise several different applications that support the needs of health
care organizations, clinicians, patients and policy makers in collecting and
managing all the data related to both clinical and administrative processes.
(Rada, 2008)

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ARCHITECTURE OF HEALTH INFORMATION SYSTEM
• An architect develops a blueprint that shows what and where different rooms in a
house will be or what it will look like.
• In addition, their blueprint must contain fundamental elements that will allow the
house to be built, including several key systems - like plumbing and heating
systems.
• Health information system architecture describes the fundamental organization
of the system embodied in its components, standards, and principles governing
its design and evaluation.
• In doing so, multiple systems can be aligned with a shared outcome for a health
information system.
• Because inputs like social, legislative/regulatory, and physical contexts are
considered, a health information system architecture can guide the design and
selection of systems, and govern how they interact.
• This can result in a health information system that is flexible, works in a country’s
context, and reduces duplication.

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ARCHITECTURE OF HEALTH INFORMATION SYSTEM

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ARCHITECTURE : CASE STUDY
• Nyasha is a patient enrolled in HIV care at the Narayana Health Hospital.
• Every six months, Nyasha comes to the hospital’s HIV clinic for a regular visit to check her
viral load and have a thorough exam.
• The nurse assistant gathers the following information: Nyasha’s weight, blood pressure,
and other vital signs. The clinician notes symptoms and other observations from the
physical exam.
• Upon physical exam, the clinician has noticed signs of possible TB infection and so sends
Nyasha to the radiology department along with an order for a chest x-ray.
• The radiologist must send the x–ray results back to the clinician.
• Nyasha’s provider also sends an order to the lab for a viral load count.
• The lab technician receives the order and must transmit the viral load results back to the
clinician.
• At the end of her visit, Nyasha gets a prescription that she must get filled at the pharmacy.
The pharmacy charges a small fee for this month’s supply of medication.
• 1. What information must be recorded during this visit to Narayana Health Hospital ?
• 2. Where will all this data be recorded?

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ARCHITECTURE : CASE STUDY
What information must be recorded during this visit to Narayana Health Hospital ?
The following information must be recorded during Nyasha’s visit to Narayana Health
Hospital:
1. Nyasha’s vital signs
2. Notes from the physical exam
3. X-ray order
4. X-ray results
5. Lab test order
6. Lab test results
7. Medication prescription
8. Pharmacy bill
9. Date of Nyasha’s next appointment

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ARCHITECTURE : CASE STUDY
Where will all this data be recorded?
• Nyasha’s paper patient chart from the old system is replicated in an Electronic Medical
Record System.
• The laboratory technician will log the viral load test order, information about the test, and
its results in the Laboratory Information System.
• The test result will also be included in the Electronic Medical Record as part of Nyasha’s
chart.
• The pharmacy has a Pharmacy Information System in which Nyasha’s prescription
information will be logged and medication supplies are tracked.
• Nyasha’s medications must also be noted in the patient chart.
• In addition to the systems that will record data from Nyasha’s visit, the hospital likely uses
a Billing System to track fees charged and paid.
• A Stock Management System may be used to track, forecast, and order supplies like lab
reagents, test kits, and gloves.
• An Equipment Maintenance System may be used to log information about x–ray or
laboratory equipment location, condition, and maintenance.
• The hospital may use a Human Resources Information System to track hospital staff
information like training needs, salary scales, contact information, and staffing planning.

9. LAYERS IN A HOSPITAL
INFORMATION SYSTEM
Health Information Systems.ppt

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HOSPITAL INFORMATION SYSTEM : DOMAINS
Layer 1
• Patient Care: Patient care can be discussed in a holistic manner by considering each and
every aspect of the patient data right from the time of admission.
1. Appointment: preventing the long queue of patients.
2. Administrative admission: assignment of case identification number (CIN) (MRN) Medical
Record Number in order to classify people as per their clinical problem.
3. Medical admission: conducted by doctor as per ICD/DSM and organization/medical
protocol
4. Nursing admission: conducted by nurse as per organization/medical protocol
5. Visitor and information service: availability of beds, and other facilities.

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HOSPITAL INFORMATION SYSTEM : DOMAINS
Layer 1

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HOSPITAL INFORMATION SYSTEM : DOMAINS
Layer 1

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HOSPITAL INFORMATION SYSTEM : DOMAINS
Layer 1
• Supply and disposal management, scheduling and resource allocation: The hospital has to
ensure that there is adequate amount of supply for the patient care.

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HOSPITAL INFORMATION SYSTEM : DOMAINS
Layer 1
• Hospital Management: The overall management of hospital that focus on goal attainment. It
includes planning and execution of strategies, HR, budget, investments, treatment
modalities.
• Hospital Administration: Emphasis on overall coordination of hospital managaent.
• Research and Education: Tool of EBP

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HOSPITAL INFORMATION SYSTEM : DOMAINS
Layer 2
• Logical Tool: Applications comprises of functioning of health information system. It includes
patient administration system, medical and nursing management, documentation, OPD
management, health professional entry system, Radiographic an diagnostic systems,
pharmacy, non medical systems. This facilitates the decision making process.
Layer 3
• Physical Tool: Physical data processing systems required to install the application
components. It includes servers, communication networks.

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ARCHITECTURE : TYPES
Stand-Alone System
• A stand-alone system is usually limited to one context: one clinic, or one hospital
department like the lab or maternity.
• This type of system is not connected to other systems. The information stays in that
system and doesn’t move.
• It contains all the data necessary to effectively log inventory and maintenance, but when
the equipment manager needs to share data with the district Health authority, they must
take the data, export it to a spreadsheet or other form and then email that form to the
district.
Advantages and Limitations:
• The stand-alone architecture’s simplicity makes it easier to troubleshoot when the user or
system runs into difficulty.
• However, sharing information between actors within a facility—such as relaying lab
results to the primary care provider—or across reporting levels—such as aggregating
data from multiple clinics— is difficult.
• A stand-alone system generally means that information sharing must take place
externally to the system.

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ARCHITECTURE : TYPES
Centralized System
• Centralized systems have a single database.
• This database may also be known as a central repository or warehouse that contains all
the entered data, no matter where it is entered.
• You can have a single data entry point or many, within a single facility or multiple facilities.
• The cloud is often used to house a centralized repository for data that can be entered
from any internet-connected point.
• A hospital with a multi-departmental electronic medical record system. No matter where
the patient is being treated in the hospital— inpatient ward, maternity ward, surgery— the
provider can access the EMR and enter data for that patient.
• The centralized system is distinguished from the stand-alone system by its connectivity.
Advantages and Limitations:
• This architecture makes accessing data from multiple places much easier.
• It can be created easily because you implement the same thing everywhere.
• It does, however, require substantial technological infrastructure and policy framework to
support communication between the data entry point and the central repository, and to
ensure the security of the information as it passes between units.
• If the central repository breaks down, the entire system is unusable.

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ARCHITECTURE : TYPES
De-centralized System
• Let’s look at an example that is a little more complex: the de-centralized system.
• Unlike a centralized information system architecture, a de-centralized system architecture
can have multiple databases or repositories that collect data from many sources.
• It is usually accessed by the user through one entry screen.
• For example, District Health Information Software (DHIS) has been implemented in India
using a de-centralized model, where users enter data from multiple facilities into multiple
databases.
• These databases are accessed by stakeholders.
Advantages and Limitations:
• Depending on how access is managed, this architecture can ensure wide accessibility, or
limit information to certain actors or levels.
• The infrastructure needs vary widely, as well.
• Strong security measures and protocols are necessary to protect the information.

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ARCHITECTURE : TYPES
Federated System
• A federated system architecture brings data and information from individual systems into a
shared data warehouse.
• The centralized repository often receives only a subset of the data available in each
system’s repository.
• In a way, a federated system is therefore a blend of centralized and de-centralized systems.
• For example, NGO Alpha has 15 clinics that run on System A. NGO Beta has 100 clinics
that run on System B. Both Alpha and Beta must report some of their data to the national
system, System A and System B connect with Nat Dat to automatically send the required
data on a regular basis.
Advantages and Limitations:
• Federated architecture involves multiple actors, each with their own goals, needs, and
structure.
• With this architecture, each actor can share core information and address their individual
needs without losing their autonomy.
• It is important to clarify who owns the data in this type of architecture. Clearly defining
standards of integration—e.g., making sure that everyone reports the same thing
accurately—is essential.

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Comparison of centralized versus federated architectures. In the centralized architecture, each institution
must upload their data to a centralized web server while in the federated architecture, data stay at their
respective institutions, but each institution must implement an interface to make the data findable but not
necessarily accessible.

21. CLINICAL/HOSPITAL INFORMATION SYSTEM

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HOSPITAL INFORMATION SYSTEM
• A hospital information system (HIS) is an element of health informatics that focuses
mainly on the administrational needs of hospitals.
• In many implementations, a HIS is a comprehensive, integrated information
system designed to manage all the aspects of a hospital's operation, such as medical,
administrative, financial, and legal issues and the corresponding processing of services.
Hospital information system is also known as hospital management software (HMS)
or hospital management system.
• Hospital information systems provide a common source of information about a patient's
health history, and doctors schedule timing.
• These systems enhance the ability of health care professionals to coordinate care by
providing a patient's health information and visit history at the place and time that it is
needed.
• HIS provide internal and external communication among health care providers. Portable
devices such as smartphones and tablet computers may be used at the bedside.
• Hospital information systems are often composed of one or several software
components with specialty-specific extensions, as well as of a large variety of sub-systems
in medical specialties from a multi-vendor market.

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HOSPITAL INFORMATION SYSTEM - DEFINITION
• A hospital information system (HIS) is a unified, computer
assisted system constructed to store, process, retrieve and
analyze information related to the administrative and clinical
aspects of providing services within the hospital setting.
• HIS refers to a system conceptualized to manage healthcare
data with a special focus on collecting, storing, managing
and transmitting a patients’ EMR, a hospital’s operational
management or a system supporting healthcare policy
decision.

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HOSPITAL INFORMATION SYSTEM - OBJECTIVES
• To enhance the quality of patient care through the integration of data
driven by the computer-based technology.
• To provide accurate, electronically stored medical records of the patients.
• To support the health care professionals in the clinical settings to manage
activities related to patient care.
• To regulate the administrative functions.
• To evaluate the performance of the hospital.
• To assess the future requirements of the given setting for educating and
training the staff.
• To serve as the source of data for research.
• To aid in the process of decision making.
• To enhance interoperability of patient’s data.
• To allocate scarce resources optimally.

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INTEGRATED HOSPITAL INFORMATION SYSTEM

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Need for HIS
• Efficient and accurate administration of finance, diet of patient, engineering, and distribution
of medical aid.
• It helps to view a broad picture of hospital growth.
• Improved monitoring of drug usage, and study of effectiveness.
• This leads to the reduction of adverse drug interactions while promoting more appropriate
pharmaceutical utilization.
• Enhances information integrity, reduces transcription errors, and reduces duplication of
information entries.
• Hospital software is easy to use and eliminates error caused by handwriting.
• New technology computer systems give perfect performance to pull up information from
server or cloud servers.
• Improve policy making
• Data safety and patients privacy

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Forms of HIS
• Clinical Decision Support: Clinical decision support (CDS) provides clinicians, staff, patients
or other individuals with knowledge and person-specific information, intelligently filtered or
presented at appropriate times, to enhance health and health care. CDS encompasses a
variety of tools to enhance decision-making in the clinical workflow.
• Electronic Medical Record (EMR) and Electronic Health Record (EHR): Electronic medical
records (EMRs) are a digital version of the paper charts in the clinician’s office. An EMR
contains the medical and treatment history of the patients in one practice. EMRs have
advantages over paper records. For example, EMRs allow clinicians to Track data over
time, Easily identify which patients are due for preventive screenings or checkups. Check
how their patients are doing on certain parameters—such as blood pressure readings or
vaccinations and Monitor and improve overall quality of care within the practice.
• Electronic health records (EHRs) do all those things and more. EHRs focus on the total
health of the patient, going beyond standard clinical data collected in the provider’s office
and inclusive of a broader view on a patient’s care. EHRs are designed to reach
out beyond the health organization that originally collects and compiles the information.
They are built to share information with other health care providers, such as laboratories
and specialists, so they contain information from all the clinicians involved in the patient’s
care.

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Forms of HIS
• Patient Portals; Facilitates patient access such as appointment information, medications,
and lab results over a network.
• Master Patient Index: MPI is an index of all patients registered for service.
• Practice Management Software: Managing daily administrative functions such as
registration, scheduling, billing etc.
• Remote Patient Monitoring: RPM is an integration of Tele-health and tele-nursing with
patient management system.

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Advantages and Disadvantages of HIS

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Recent Trends in HIS

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Recent Trends in HIS

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Recent Trends in HIS

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Recent Trends in HIS

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Recent Trends in HIS

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Recent Trends in HIS

36. THANK YOU
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