Computers in hospitals

Published on 12/06/2015 by admin

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4 Computers in hospitals

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: Radiological Information System (RIS) Hospital Information System (HIS) 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. Picture Archiving and Communication Systems (PACS) Electronic Patient Record (EPR) Electronic Remote Requesting System (RRS) Radiological Information System (RIS) • DICOM is the protocol used so that the different parts can communicate with each other 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
Web-based Integration	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
Digital Imaging and Communications in Medicine (DICOM)	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: Patient name Address Date of birth Hospital number NHS number Next of kin, etc. • Includes: Hospital records GP records Discharge summaries Clinical letters 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. Hospitals Laboratories Primary Care Trusts and 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
Hospital Information System (HIS)	Aims to contain all patient information, e.g. • Individual details: Patient name Address Date of birth Hospital number NHS number General Practitioner Next of kin, etc. • Reports from clinical investigations, e.g. Imaging Bronchoscopic investigations Endoscopy Tissue cultures, etc. • Laboratory test results Biochemistry Bacteriology Haematology Immunology Virology, etc. • Additional information Hospital admissions Out patient appointments 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: Hospital wards Out-patient clinics GP surgeries
Order Communications (OCM)	• Each department being accessed requires a standardised request form on the system, e.g. Imaging Haematology Pathology, etc.
	Structure • A module of HIS • Must be integrated with RIS to be able to access: Previous imaging procedures Previous reports Room availability and booking • Must be integrated with PACS to allow: 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: Booking appointments Allocating rooms Storing reports 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. If the patient is unconscious 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. Adding additional examinations Changing incorrect requests, e.g. right for left • The patient is imaged • The patient leaves • The operator records: The name of the person undertaking the examination The room used Size and number of films taken Exposure details 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: When a film is removed The date and time it is removed The name of the person requesting the film file Date and time of its return • It can also be interrogated to identify: Who last requested a film file 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