HIS

Section-G
EIS
 Overview of Hospital Information Systems

Information technology has made a significant impact on the healthcare sector. The past decade
has witnessed the foray of numerous information systems and their resultant products into the
hospital scenario. The number of investments in computers and types of hospital systems has
increased. This is because paper medical records are cumbersome, bulky to use and difficult to
manage. On the other hand digital records are much easier to handle and improve the workflow
efficiency by integrating various tasks.
The ultimate objective is to build a network of interdependent centers such as the clinical
laboratory, radiology department, pharmacy, and so on in order to effectively meet the needs
arising within the hospital. Despite the fact that these individual centers are autonomous, they are
interdependent in terms of delivering services and to ensure effectiveness of providing care. All
this can be achieved through hospital information systems (HIS) that have formed the
cornerstone of today’s modern hospital.
A Hospital Information System (HIS) can be defined as a computerized system that is designed
to meet all the information needs within a hospital. This includes diverse data types such as
patient information, billing, finance and accounting, staffing and scheduling, pharmacy ordering,
prescription handling, supplies, inventory, maintenance and orders management, diagnostic
reports related to laboratory, radiology and patient monitoring as well as providing decision
support.

Functional Model of a Hospital Information System

            

Information requirements can be

grouped as:
 Operational requirements, which
include up-to-date factual information
that are necessary for day-to-day tasks
 Planning requirements that
comprise of short- and long-term
decisions about patient care and
decisions about hospital management
 Documentation requirements such as maintenance of records, accreditation and legal
records

From admission to diagnostic and medical support services, the modern healthcare centers rely

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on wide range of software applications. Some of the distinctive advantages of HIS include
improved quality of patient care, improved communications within the hospital, increased
productivity, reduced costs and reduced chances of errors and the enhanced ability to track
patient records. Today HIS and electronic medical records (EMR) have become the minimum
prerequisites for delivering quality healthcare.

Computer-based patient record (CPR)

The computer-based patient record (CPR) (or electronic patient record, EPR) offers health
professionals

• Complete patient data displayed in an integrated fashion that facilitates medical decision
making

• Access from any workstation in the hospital

• Ability to enter orders, notes, data at same workstation

• No double entry of information

• Immediate availability of results

• Simultaneous users can access same medical record

• Access from on site or remote locations

• No loss of patient information

However, initial costs, the necessity to change workflow, and employee’s reluctance to accept
the new technology are mayor problems when introducing CPR in a hospital.

Implementation
An information system, that combines a computer-based patient record with other modules that
support clinical workflow is called a hospital information system (HIS). As early HIS date back
to the 1970s, modern more comprehensive approaches are sometimes labeled differently (clinical
information system, CIS, health-care informtion system, HCIS), but definitions are not precise.
Some important modules of an HIS are the following:

• Medical devices: access to medical devices via standardized protocols (DICOM) and/or
Picture Archiving and Communications System (PACS)

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 • Telemedicine: access to external data (e.g. receive patient data from physician, notify
physician electronically, send and receive medical images), typically by means of internet
access via firewall.

• Scheduling: Staff can electronically make appointments with physicians, X-ray,

laboratories, etc..

• Billing: import, view, approve charges posted by therapists, file electronic claims and/or
print claims, create reports (by patient, therapist, ward, clinic, diagnosis, etc.) to analyze
individual and group productivity and financial performance.

 On-Line Transaction Processing (OLTP) systems based on relational databases are

suitable for recording business transactions. They record information in two dimensions
and automate repetitive tasks. Structured Query Language (SQL) is typically used to
access information and results are presented in the form of reports which doctors use to
make clinical decisions. Fig. 1(a) shows a simple OLTP Entity-Relationship Diagram
(ERD) consisting six tables and Fig. 1(b) shows a simple SQL query to analyze

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 relationship between hospitals and patients. OLTP has a major drawback. Large amounts
of data in normalized form require many joins even to answer simple queries. For
example, to analyze relationships between hospital and patients (Fig. 1), the query would
require several table scans and multi-way table joins which can degrade performance
significantly. It requires at least four inner joins across five tables (Fig. 2). A real-life
database will have many tables and the time taken to process the joins will be
unacceptable.

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…………………………………………………………………………………………………….
A Real time Implementation

Entity and Relationship sets for HIS

Patients, Doctors, Beds, Examines, BedAssigned, Accounts, HasAccount.

 patients, entity set with attributes SSNo, LastName, FirstName, HomePhone, Sex,

DateofBirth, Age, Street, City, State, Zip.
 doctors, entity set with attributes SSNo, LastName, FirstName, OfficePhone, Pager,
Specialty.
 examines, relational set with attributes Date, Time, Diagnosis, Fee.
 beds, entity set with attributes RoomNumber, BedNumber, Type, Status, PricePerHour.
 Bed_assigned, relational set with attributes DateIn, TimeIn, DateOut, TimeOut, Amount.
 accounts, weak entity set with attributes DateIn, DateOut, Amount.
 has_account, relational set with no Attributes

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E-R Diagram

Hospital Relational Model

 Patients = {SSNo, LastName, FirstName, HomePhone, Sex, DateofBirth, Age, Street,

City, State, Zip}

Relational Dependencies = {SSNo à LastName, FirstName, HomePhone, Sex,DateofBirth,

Street, City, State, Zip; Zip à City, State; DateofBirth à Age}

 Doctors = {SSNo, LastName, FirstName, OfficePhone, Pager, Specialty}

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 Doctors Relational Dependencies = {SSNo à LastName, FirstName,OfficePhone,
Specialty}

 Examines = {PSSNo, DSSNo, Date, Time, Diagnosis, Fee}

Examines Relational Dependencies = {

, relational set with attributes Date, Time, Diagnosis, Fee.

 Beds = {RoomNumber, BedNumber, Type, Status, PricePerHour}

Beds Relational Dependencies = {

 Bed_Assigned = {PSSNo, RoomNumber, BedNumber, DateIn, TimeIn, DateOut,

TimeOut, Amount}

Bed_Assigned Relational Dependencies = {RoomNumber, BedNumber, DateIn, TimeIn,

DateOut, Time.Out à Amount},

 Accounts = {SSNo, DateIn, DateOut, Amount}

Accounts Relational Dependencies = {

3NF Translation

Patients:

Patients1 = { SSNo, LastName, FirstName, DOB, Sex, Street, Zip}

Patients2 = { DOB, Age}

Patients3 = { Zip, City, State}

Doctors:

Doctors = { SSNo, LastName, FirstName, Specialty, OfficePhone, Pager}

Examines:

Examines = { Doctors.SSNo, Patients1.SSNo, Date, Time, Diagnosis, Fee}

Accounts:

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Accounts = {Patients1.SSNo, DateIn, DateOut, Total}

Beds:

Beds = { Room#, Bed#, PricePerHour, BedType, Status}

Bed_Assignment:

Bed_Assignment = { SSNo, RoomNumber, BedNumber, DateIn, DateOut, TimeIn, TimeOut,

Amount}

Queries and Transactions

/* List all patient information */

SELECT *
FROM Patients, PatAddr, PatAge
WHERE Patients.Dob = PatAge.Dob and Patients.Zip = PatAddr.Zip and ( Patients.SSNo =
"@Prompt" or (Patients.LastName = "@LastName" and Patients.FirstName = "@FirstName"))

/* List current patients */

SELECT SSNo, LastName, FirstName, RoomNumber, BedNumber, Account.DateIn

FROM Patients, Accounts, BedAssignments
WHERE Patients.SSNo = Accounts.SSNo and Patients.SSNo = Bed_Assignments.SSNo and
Accounts.DateOut = NULL

/* Given doctors name list all patients visited. */

SELECT Patients.SSNo, Patients.LastName, Patients.FirstName, Date, Fee, Diagnosis

FROM Patients, Examines 
WHERE SSNo=PSSNo and DSSNo in (SELECT SSNo
FROM Doctors
WHERE FirstName= "@FirstName" and LastName = "@LastName)

/* Given Doctors name list all patients he is currently treating. */

SELECT PSSNo, Patients.LastName, Patients.FirstName, Date, Fee, Diagnosis

FROM Patients, Examines, Accounts
WHERE Accounts.SSNo= Patients.SSNo and Patients.SSNo=PSSNo and Accounts.DateOut =
NULL 
And

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DSSNo in (SELECT SSNo
FROM Doctors
WHERE FirstName= "@FirstName" and LastName = "@LastName and )

/* Admit a patient

/* Given SSNo Search for past Accounts.

SELECT * 
FROM Patients
WHERE SSNo = "@SSNo" into TEMP

/* Enter patient Data into input screen. */

If TEMP = Null then

INSERT into Patients
VALUES( @LastName, @FirstName, @SSNo, etc.*)
INSERT into ACCOUNTSSELECT 
ELSE
UPDATE Patients
Set LastName="@LastName", FirstName= "@FirstName" etc.
WHERE Patients.SSNo = "@SSNO"
End

/* Add new Account Record */

INSERT into Accounts

VALUES ( DateIn= "Current Date", SSNo="@SSNo")

/* end of Admitting Patient */

/* Checkout patient */

SELECT BedAssignments
WHERE DateOut = Null and SSNo = "@SSNo"
AS TEMP
If TEMP <> NULL then
Call transfer Patient out of Bed
END
UPDATE Accounts
SET Account.Amount = (SELECT ( SUM(BedAssignment.Amounts) + SUM(Examines.Fees))
FROM Examines, BedAssignements, Accounts

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WHERE SSNo = "@SSNo" and BedAssignments.DateIn >= Account.DateIn
and Examines.Ssno = Patients.SSNo and Accounts.SSNo = Patients.SSNo)
WHERE Accounts.SSNo = "@SSNo"

/* end of Check out patient */

/* Transfer out of bed */

/* Transfer into bed */

/* Transfer to new bed */

Next Steps

Creation of Final Tables for working model.

Formation of Final Queries and Transactions as Stored Procedures on SQL 6.5 Server.

Description of the Front-end Client created using Visual basic 6.0

SQL scripts of all objects for the GeneralHosp commands.

Conclusion

The introduction of information systems in hospitals and other medical facilities is not only
driven by the wish to improve management of patient-related data for the patient’s benefit, but
also by the fiscal necessity to improve efficiency of medical services.

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