Computers in hospitals

Published on 12/06/2015 by admin

Filed under Radiology

Last modified 22/04/2025

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4 Computers in hospitals

The Advantages of Computerisation

Eliminates Repetitive Tasks
• Repetitive form-filling not required
• Once a patient’s name has been entered, it should not have to be re-entered
Eliminates Paper Handling and Filing Elimination of hardcopies of:

• Request forms
• Reports
• Films
• Paper records
• Referral letters
Improves Interdepartmental Communications Virtually instant access to:

• Existing patient records films/images
• Previous reports
• New images and reports
• Laboratory tests and results
• Referral letters
Improves efficiency Elimination of:

• Manual filing of films/images
• Manual retrieval of films/images
• Need to copy images
• Need to file images separate from patient records
Improves Confidentiality and Security
• Files, reports and patient details can be very secure
• Passwords would only allow access to specific levels of information
Automated Data Collection Improves information handling on, e.g.:

• Staffing
• Budgeting
• Patient attendances
• Use of equipment
• Servicing
• Research

The Patient Journey

Overview
• Examination request is made, including clinical details
• The request is accepted (or rejected)
• The appointment is made
• Instructions and information sent to the patient
• DICOM worklist is generated
• The examination is completed and it is electronically signed that the work has been done
• Images sent to PACS
• PACS acknowledgement of receipt of the images
• Additional examinations/images added to file using PACS and DICOM
• The image, notes and clinical details placed on PACS workstation
• Image is reported on using voice recognition software
• The report is electronically signed
• Text is automatically available on:

image Radiological Information System (RIS)
image Hospital Information System (HIS)
image Electronic Patient Record (EPR)
Integrating Health Enterprise (IHE) An initiative introduced in 1999
Aim:

• To bring together manufacturers of clinical information systems, PACS systems and imaging equipment
• To talk about integration requirements and systems
Individual Computer Systems Overview

• The hospital information system (HIS) is the central hub
• Other systems are linked to it, e.g.

image Picture Archiving and Communication Systems (PACS)
image Electronic Patient Record (EPR)
image Electronic Remote Requesting System (RRS)
image Radiological Information System (RIS)

• DICOM is the protocol used so that the different parts can communicate with each other
image

Fig. 4.1 Individual computer systems.
Web-based Integration Works in a similar way to the World Wide Web and has:

• An internet server
• A search engine
• Stores information on the web
• RIS and HIS, etc. are stored as data sets
• User can browse the individual data sets
Advantages

• Upgrades can be done on the central server
• Navigation is done using a mouse
• Hyperlinks can be used to aid the search facility
Digital Imaging and Communications in Medicine (DICOM) An initiative sponsored by the Radiological Society of North America and the Health and Management Systems Society
Aim

• To integrate information and management systems so that clinical information can be communicated among all specialities and providers
• Any doctor will eventually have access to a wide range of tests and images, on computer
• The primary concern is patient confidentiality
• Now accepted worldwide in the imaging field (See DICOM p. 3)
Health Level 7 (HL7)
• A standard less well designed than DICOM
• Used for HIS and RIS systems
• Originally used by North American manufacturers
• HL7 and DICOM equipment can be integrated together
Picture Archiving and Communication Systems (PACS)
• PACS is a method of storing images in a digital format
• Once stored, they can be sent to different parts of the hospital and to the wider medical community.
• (See PACS p. 59)
Electronic Patient Record (EPR) Aims to contain

• Individual details:

image Patient name
image Address
image Date of birth
image Hospital number
image NHS number
image Next of kin, etc.

• Includes:

image Hospital records
image GP records
image Discharge summaries
image Clinical letters
image Prescribing data

• Information added to the record is automatically added to the other systems (e.g. HIS, PACS, RIS)
Hospital Information System (HIS)
• A computerised system, the aim of which it to build a network of complementary centres, e.g.

image Hospitals
image Laboratories
image Primary Care Trusts and
image GP centres, etc. spread throughout Europe

• To meet the social and healthcare needs in each area
• The term can also be used to define the system used in an individual hospital or unit
Aims to contain all patient information, e.g.

• Individual details:

image Patient name
image Address
image Date of birth
image Hospital number
image NHS number
image General Practitioner
image Next of kin, etc.

• Reports from clinical investigations, e.g.

image Imaging
image Bronchoscopic investigations
image Endoscopy
image Tissue cultures, etc.

• Laboratory test results

image Biochemistry
image Bacteriology
image Haematology
image Immunology
image Virology, etc.

• Additional information

image Hospital admissions
image Out patient appointments
image Discharge information

• Information added to the record is automatically added to the other systems (e.g. EPR, PACS, RIS)
• Only a limited number of people can input data to ensure accuracy of the information held
Electronic Remote Requesting System (RRS))
• A method of electronically requesting tests and examinations from:

image Hospital wards
image Out-patient clinics
image GP surgeries
Order Communications (OCM)
• Each department being accessed requires a standardised request form on the system, e.g.

image Imaging
image Haematology
image Pathology, etc.
Structure

• A module of HIS
• Must be integrated with RIS to be able to access:

image Previous imaging procedures
image Previous reports
image Room availability and booking

• Must be integrated with PACS to allow:

image Clinical reports and images to appear on the diagnostic workstations
Advantages

• Electronic generic request forms
• Patient information can be obtained from HIS
• Elimination of paper request forms
• Reports have only to be entered once
• Digital signing of forms using a code for patient security
Disadvantages

• If standardised lists are used, e.g. reasons for imaging requests, the exact reason may not be on the list
• Digital codes can be passed on to unauthorised users
Radiological Information System (RIS)
• RIS is a text-based computer system for:

image Booking appointments
image Allocating rooms
image Storing reports
image Auditing workflow of all staff
Using the system

• Request for examination is received
• User logs on – so that a record is kept of the people using the system
• HIS is checked to see if the patient is on the system
• Note systems advise if a duplicate entry is suspected
• An RIS number is allocated
• If not on the system (if they have not attended the hospital before as an in-patient or out-patient) an RIS number is allocated
• If the patient details are not known, a local protocol needs to be in place to allocate an RIS number, e.g.

image If the patient is unconscious
image Protocols could include a date of birth of 30 February, etc.

• If the patient information requires changing on HIS (e.g. a change of address), on modern systems this can be done from RIS
• A worklist is generated
• When integrated with PACS the reports can be added to the images
Imaging the patient

• The operator logs on
• The patient details are checked
• The order is modified if necessary, e.g.

image Adding additional examinations
image Changing incorrect requests, e.g. right for left

• The patient is imaged
• The patient leaves
• The operator records:

image The name of the person undertaking the examination
image The room used
image Size and number of films taken
image Exposure details
image Comments

• The operator logs off
Reporting

• The images are viewed on a workstation
• Previous images can be viewed alongside
• Voice activated software can be used for reporting
• The report can be stored on RIS
• The report and images can be available on PACS
Auditing
The system can be used for auditing and creating management reports, e.g.

• Staffing
• Room usage
• Budgeting
• Patient attendances
• Time taken for examinations
• Use of equipment
• Ordering information
Links to conventional film filing system

• Can be used as a database for the conventional system by logging:

image When a film is removed
image The date and time it is removed
image The name of the person requesting the film file
image Date and time of its return

• It can also be interrogated to identify:

image Who last requested a film file
image When they requested it

• Automatically generate letters requesting the return after a set length of time
• Clinics can generate requests for film files prior to appointments
• Ideally HIS would automatically request film files prior to clinics to allow for the files to be obtained

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