Clinical Information Systems

(CIS), Hospital Information

Systems (HIS) & Electronic
Health Records (EHRs)
Nawanan Theera-Ampornpunt, M.D., Ph.D.
Department of Community Medicine, Ramathibodi
Sep 20, 2014

http://www.slideshare.net/nawanan

What is an information system?

Information System
Information System
A system using information technology to
support certain human work processes
Uses technology as a tool to deliver
information and support business
processes to users in a certain task
Examples: Bank teller systems, online
course registration systems, e-learning
systems, flight reservation systems

Connecting data from various places

Fast processing
Collaborative work
Reducing errors or inconsistencies in the
process

Image Source: http://en.wikipedia.org/wiki/Logistics_automation

Components of Information Systems

IT Infrastructure
- Servers & Clients
- Network

- Users

Hardware

Software

Peopleware

Data

- Operating System
- System Utilities
(such as antivirus)
- Applications (such as
Microsoft Word,
Hospital Information
System)

- Data stored in the

sytem

ATM

Image Source: http://www.gsb.or.th/products/personal/services/atm.php

Flight Departure Display

Image Source: http://www.m7worldwide.com/checkaflight.html

EHRs: Fundamentals

What Is A Medical Record?

What Is A Medical Record?

A record or documentation of a patients
medical history, examination, and treatments.
Medical Record vs. Health Record
Essentially the same

Class Discussion 1

Why do we need a health record?

In other words, why do we need a
documentation of a patients medical care?

Potential Uses of Medical Records

Continuity of providing care
Note important information for later use
Especially important in chronic diseases
(e.g. hypertension, diabetes) or in follow-up (e.g. after
surgery)

Patient safety
Preventing something bad because of lack of information
Such as drug allergies, list of current medications,
problem list

Potential Uses of Medical Records

Communications between providers
Referral to specialists or other physicians
Consulting among physicians
Communications between physicians and nurses,
pharmacists, physical therapists, etc.
Transfer from a hospital to another

Medico-legal purposes
e.g. Court evidence against malpractice
What was done or provided to the patient? Why? By
whom? When?
Was the care provided up to the professional standard?

Potential Uses of Medical Records

Claims and reimbursements
What services were provided to the patient
How (and how much) will the hospitals/doctors be paid?
Audit of medical records by payers

Patients uses
Health insurance claims
Self-education & self-care

Clinical research
Find ways to improve health care through new knowledge

Electronic Medical Records

Electronic Medical Records (EMRs) vs.
Electronic Health Records (EHRs)

Debate about similarities & differences

Summary
Definitions subjective, depending on how people think
EMRs mostly refer to electronic documentation of
medical care at one visit
EHRs mostly refer to electronic documentation that is
longitudinal in nature (may be several visits)
EMRs commonly used in Thailand (but means the same
as EHRs)

Longitudinal Records
Records documented over time (multiple encounters)
Ideally, life-long is a complete record of the patients health

Various Forms of Health IT

Hospital Information System (HIS)

Computerized Provider Order Entry (CPOE)

Electronic
Health
Records
(EHRs)

Picture Archiving and

Communication System
(PACS)

Still Many Other Forms of Health IT

Health Information
Exchange (HIE)

m-Health
Biosurveillance
Personal Health Records
(PHRs)

Information Retrieval

Telemedicine &
Telehealth
Images from Apple Inc., Geekzone.co.nz, Google, PubMed.gov, and American Telecare, I

The Confusing Acronyms

Computer-Based
Patient Records
(CPRs)

Electronic Medical
Records (EMRs)

Electronic Patient
Records (EPRs)

Electronic Health
Records (EHRs)
Personal Health
Records (PHRs)

Hospital
Information
Systems (HIS)

Benefits of EHRs

Class Exercise 3

Why do we need to use an

electronic version of medical
records?

Why We Need Health IT

Health care is very complex (and inefficient)
Health care is information-rich
Quality of care depends on timely availability &
quality of information
Clinical knowledge body is too large
Short time during a visit
Practice guidelines are put on-the-shelf
To prevent human errors

Benefits of Going Electronic (EHRs)

Ubiquitous availability (anytime, anywhere, everyone who is
authorized)
Multiple concurrent uses
The end of Where the heck is the patients record?!?
Ability to control & enforce access security
Structured data entry possible
Data presentation that is easier to understand (e.g. graphs)
Efficiency in data entry? (but sometimes it slows users
down!)
Process improvement (business process
reengineering/redesign, quality improvement)

No doctors handwriting!!!!!

Electronic Health Record (EHR) Systems

Are they just electronic documentation?

History
& PE

Diagnosis

Treatments

Or do they have some other values?

...

Literature Shows Benefits of Health IT

Literature suggests improvement in health care
through
Guideline adherence
Better documentation
Practitioner decision making or process of care
Medication safety
Patient surveillance & monitoring
Patient education/reminder
Cost savings and better financial performance
Alerts & Reminders

Alerts & Reminders

Functions That Should be Part of

EHR Systems

Patient Demographics
Physician Notes
Computerized Medication Order Entry
Computerized Laboratory Order Entry
Computerized Laboratory Results
Problem Lists
Medication Lists
Discharge Summaries
Diagnostic Test Results
Radiologic Reports

Clinical Information Systems

& Hospital Information Systems

Software Applications in Hospitals

Front Office
Electronic Health Records (EHRs)
Hospital Information Systems (or Clinical Information Systems)

Back Office

Management Information Systems (MIS)

Enterprise Resource Planning (ERP) systems
Research and Education
Office Automation Tools (such as Microsoft Office)

Examples of Hospital IT
Enterprise-wide
MPI, ADT
EHRs/EMRs/HIS/CIS
CPOE & CDSSs
Nursing applications
Billing, Claims & Reimbursements
MIS, ERP

Examples of Hospital IT
Departmental Applications
Pharmacy applications
LIS, PACS, RIS
Specialized applications (ER, OR, LR, Anesthesia,
Critical Care, Blood Bank)
E-Learning

Hospital Information System

Medical
Records

Clinical
Notes

ADT

Workflow
Pharmacy IS
Operation
Theatre

Master
Patient
Index (MPI)

LIS

Order

CCIS

Portals

RIS
Scheduling

Billing

PACS

Modified from Dr. Artit Ungkanonts slide

Hospital Information System

From Dr. Artit Ungkanonts slide

Master Patient Index (MPI)

A hospitals list of all patients
Functions
Registration/identification of patients (HN)
Captures/updates patient demographics
Used in virtually all other hospital service applications

Admission-Discharge-Transfer (ADT)
Functions
Supports Admission, Discharge & Transfer of patients
(patient management)
Provides status/location of admitted patients
Used in assessing bed occupancy
Linked to billing, claims & reimbursements

Bed Management (from ADT System)

Insurance Eligibility System

Functions
Determines if a patient is eligible or is covered by a particular
insurance scheme
Determines the services covered by the patients insurance
plan
May need to link with the eligibility verification system of the
government agencies

Appointment Scheduling
Functions
Records appointments of patients
Pre-specified number of open slots
Ability to postpone/cancel appointments
Displays list of patients with appointments in a specific date
Ability to adjust number of open slots

Computerized Physician Order Entry

(CPOE)
Functions
Physician directly enters medication/lab/diagnostic/imaging
orders online
Nurse & pharmacy process orders accordingly
Maybe considered part of an EHR/HIS system
Values
No handwriting!!!
Structured data entry (completeness, clarity, fewer mistakes)
No transcription!
Entry point for CDSSs
Streamlines workflow, increases efficiency

Computerized Physician Order Entry

(CPOE)

Clinical Decision Support Systems

(CDSSs)
The real place where most of the values of health IT can be
achieved
A variety of forms and nature of CDSSs
Expert systems
Based on artificial intelligence, machine learning, rules, or statistics
Examples: differential diagnoses, treatment options
Alerts & reminders
Based on specified conditions
Examples: drug-allergy checks, drug-drug interaction checks, drug-lab
interaction checks, drug-formulary checks, reminders for preventive
services or certain actions (e.g. smoking cessation), clinical practice
guideline integration
Evidence-based knowledge sources e.g. drug database, literature
Simple UI designed to help clinical decision making

Clinical Decision Support Systems

(CDSSs)
PATIENT

Perception
CLINICIAN

Attention

Long Term Memory

Working
Memory

Knowledge Data

Knowledge Data
Inference

From a teaching slide by Don Connelly, 2006

External Memory

DECISION

Nursing Applications
Functions
Document nursing assessments, interventions & outcomes
Facilitate charting & vital sign recording
Utilize standards in nursing informatics
Populate and documents care-planning
Support communication within teams & between shifts
e-Kardex
Risk/incident management

Pharmacy Applications
Functions
Streamlines workflow from medication orders to dispensing and
billing
Reduces medication errors, improves medication safety
Improves inventory management

Stages of Medication Process

Ordering

CPOE

Transcription

Dispensing

Administration

Automatic
Medication
Dispensing

Electronic
Medication
Administration
Records
(e-MAR)

Barcoded
Medication
Dispensing

Barcoded
Medication
Administration

Laboratory Information System (LIS)

Functions
Receives and processes lab orders
Matches tube & specimen
Internal workflow within labs
Order processing
Specimen registration & processing
Lab results validation & reporting
Specimen inventory
Lab results viewing

Imaging Applications
Picture Archiving and Communication System (PACS)
Captures, archives, and displays electronic images captured from
imaging modalities
Often refers to radiologic images but sometimes used in other
settings as well (e.g. cardiology, endoscopy, pathology,
ophthalmology)
Values: reduces space, costs of films, loss of films, parallel
viewing, remote access, image processing & manipulation,
referrals
Radiology Information System (RIS) or Workflow Management
Supports workflow of the radiology department, including patient
registration, appointments & scheduling, consultations, imaging
reports, etc.

Billing System
Functions
Calculates service charges for services provided
Calculations based on patients insurance coverage and
eligibility
Records amount of money paid by the patient and remaining
amount
Sends information to accounting or Back Office ERP to send
reimbursement claims to government agencies

Enterprise Resource Planning

Some Functions
Finance
Accounting
Budgeting
Cost control and management
Materials Management
Procurement
Inventory management
Human Resources
Recruitment, evaluation, promotion & disciplinary actions
Payroll

The Bigger Picture:

Health Information Exchange (HIE)

Government
Hospital B

Hospital A

Clinic C
Lab

Patient at Home

Summary
EHRs (or EMRs) are both
Electronic documentation of patient care and
a broad term for an information system used to
improve the process of patient care through
better documentation and other care
processes such as ordering medications, lab
tests, or x-rays and viewing lab results and xray reports (among others)

Summary
There are various kinds of applications in
hospitals
HIS often refers to the Front Office part of
hospital IT
Sometimes HIS refers to the entire hospital IT
HIS and EHRs are used to support clinical
workflows, improve decision-making and care
quality, and reduce costs
EHRs and HIS are just one piece of the big
puzzle for the whole healthcare system

Questions?