Medical Information Systems (MIS)

1. Medical Information Systems (MIS) Group 1 Professor Burke

2. What is it? • Also known as healthcare informatics, healthcare IT, medical IT, medical informatics, nursing informatics or any combination of those terms. • A Medical Information System is a type of computer software that integrates healthcare and information technology. • Can be either system wide software or an application program, depending on use. • Overall purpose of MIS is to reduce error, increase efficiency, and most importantly, to improve patient care.

3. HOSPITAL INFORMATION SYSTEM (HIS) • HIS is a comprehensive, integrated information system designed to manage all the aspects of a hospital operation, such as medical, administrative, financial, legal and the corresponding service processing. Traditional approaches encompass paper-based information processing as well as resident work position and mobile data acquisition and presentation.

4. Conceptual model of hospital information systems

5. Core of hospital information systems • Common Data Base System • A/D/T-System • The Communication System

6. Problems • Communication • Update • Reaction • User Psychology

7. Highlights In The Future • Pictorial Data Processing and Transmission • Videotex Applications • Comprehensive Work Stations • Linkage of Expert Systems to Data Bases

8. Electronic Health Record (EHR)

9. ELECTRONIC HEALTH RECORD (EHR) • An Electronic Health Record (EHR) is a digital version of a patient’s physical medical record. EHRs are real-time snap shots of patient records that make information available instantly and securely to authorized users. • Patient administration and billing information, progress notes, diagnosis, demographics, problems, progress notes, vital signs, medications, past medical history, immunizations, laboratory data and radiology reports. • EHRs are built to share information with other health care providers and organizations.

11. ADVANTAGES OF EHRs Takes up less space. Reduce risk of error. Patient info is easily transferable. Up to date patient info is ready when needed. Improve patient and health provider connectivity. Reduce costs and improve efficiency.

12. DISADVANTAGES High costs for EHRs. Security and privacy. System crashes and viruses. Errors when imputing patient information. Not all EHRs are compatible with each other.

13. FUTURE FOR EHRs • Many health care providers believe the advantages of EHRs outweigh the disadvantages. • The adoption of electronic health records will increase as time passes. • Health care providers call for improvements in EHR functionalities. • A common health record system and geographic governance structure can help with compatibility issues.

14. Clinical Decision Support System (CDSS)

15. Definition Health version of the decision support system use by business organizations Medical information system integrated into electronic health record to help support the decisions of medical practitioners. Knowledge-based systems composing of thousands of medical data

16. Uses of CDSS Identify diagnosis for symptoms Guidelines as recommendations for prescribing medication and treatment options and ordering tests As alerts and reminders on clinical errors Generate digital imaging or screening

17. Example of CDSS • Isabel clinical decision support system- Isabel Diagnosis Checklist System • Clinical users enter patient’s symptoms and list of potential diagnosis along with recommendations of treatments options, test ordering, drugs to be prescribed will show up

18. Advantages of CDSS Provide effective and efficiency of medical workflow within medical institutions Enhance sharing of knowledge, improving clinical skills Computerized systems - Simple and easy to use so training isn’t required Reduce costs Reduce medical errors- diagnosis and drug dose errors Minimize legal liabilities Increase satisfaction (for both patients and health professionals)

19. Disadvantages of CDSS Difficulty of integrating them into other clinical systems Legal and ethical issues – there are concerns of who should be using them and when they should be used Medical professionals are relying more on the systems Security and privacy issues – systems are vulnerable to unauthorized users who might use medical information for inappropriate purposes

20. Conclusion Medical professionals can’t recall all the medical information and clinical skills and experiences they already have at the point of care Overcoming the challenges behind the applications of CDSS can certainly be beneficial for all the stakeholders of medical organizations

21. Point of Care Testing (POCT)

22. What is POCT? POCT, also known as near patient testing, is defined as any analytical test performed outside the laboratory, normally at or near the site of patient care. Most rapidly growing aspect of clinical laboratory testing. Increasing at least 10-12% per year overall. In contrast, central laboratory testing has grown 6-7% annually. Testing done by Point of Care (POC) devices. Used in several environments: Hospital bedside, clinics/physicians office, alternate care sites, home settings, major hospitals & clinics, medical centers, and pharmaceutical clinical trial sites.

23. Main Goal • Provide immediate, convenient, and easy-to-use diagnostic testing that shortens the turn around time when providing care for a patient. • improve patient outcomes • Cost effectiveness

24. History of POCT • First reported use of POCT • 1550 B.C. – Egyptian physicians used ants to link sweetness of urine to suspected diabetics. • Medieval ages • Physicians relied on direct observation of body fluids such as blood, urine, yellow bile, choleric, and phlegm to provide a diagnosis and intervention. • Period of Decline:1800-1900s • Centralized laboratories emerged as hospitals were built and testing technologies were developed. • Reemergence of POCT: Mid 1980s - Present • New technologies introduced. • Glucose and blood gas testing moved from lab to patient care settings.

25. Commonly used POC Devices • Three tests that comprise the majority of POCT in the US: • Urinalysis • Blood glucose • Urine pregnancy • Other common test include: • Haemacue, coagulation, activated clotting time (ACT), Blood gas, and viscoelastic measurement of

26. POCT Advantages • Rapid results • Small sample volume • Portability and flexibility • Lean process - testing on-site requires fewer steps than transporting a specimen to a core laboratory. • Potential to improve patient outcome. • Ability to provide laboratory testing in a wider variety of sites or circumstances. • Immediate testing reduces potential for sample deterioration

27. POCT Disadvantages • Accuracy and reliability of results • Greater inter-individual variability in results is common. • Cost per POCT are significantly higher than laboratory testing. • Number of testing personnel and capabilities • Management of POCT is challenging • POC tests employ different methods which can have unique interferences and limitations. • Documentation of testing may be problematic. • Interfacing results to a electronic patient record may be difficult.

28. Evolution of POCT Data Management Systems • Manual Records • Unreliable and difficult to maintain • Cannot be easily audited • Originally used for all POCT • Second Generation • Third Generation • Future Generation of Management System

29. Evolution of POCT Data Management Systems • First Generation • Used laptop computer that had to be carried to testing sites to download data • Usually no interface to LIS or HIS • Provided only historical testing and quality control data • Systems could only interface with a single device type from one manufacturer.

30. Evolution of POCT Data Management Systems • Second Generation • Central desktop computer connected by Ethernet to peripheral docking stations on patient care units

31. Evolution of POCT Data Management Systems • Third Generation • Similar to second generation but allows multivendor connectivity providing enterprise level data management solution.

32. Evolution of POCT Data Management Systems • Possible Future Generation of Management System • Multivendor wireless connectivity using a single data management system with bidirectional communication to a wireless-enabled POCT devices.