3.3 Health Information Systems and Applications

Abstract

Computer systems are ubiquitous and protean in healthcare. The following is a representative but by no means exhaustive list of the ever expanding role of computers in healthcare.

• 1. Electronic Health Record (EHR). The definition of an EHR is evolving. In its strictest sense, it is the electronic analog of a paper chart—a place to store observations and procedures relating to a given patient. In practice, it includes many other things (including items listed below). Some EHR functions include patient tracking, laboratory and radiology result tracking, clinical decision support, order sets, order entry with interaction checking, discharge instructions, chart templates, macros, care plans, clinical decision support and many others.

• 2. Radiology Information System (RIS) and Picture Archiving and Communication System (PACS). Although the distinction between RIS and PACS is becoming less distinct, a RIS generally manages the workflow of radiologists and technologists while a PACS stores and retrieves images. Reports are usually stored in both systems.

• 3. Laboratory Information System (LIS) . A LIS generally manages laboratory workflow, such as collecting reports from laboratory instruments and correlating them with orders received from the EHR. It provides a mechanism for laboratory specialists to disseminate results to all providers.

• 4. Supply chain management and materiel management . Caring for patients requires great deal of supplies and equipment to be available at the point of care. Making sure that these items are present in sufficient quantities and in good repair is often assisted by logistics and inventory management software. Maintaining a list of available hospital beds falls into this category.

• 5. Pharmacy management . Like other supplies, pharmaceuticals must be ordered, received, stored, dispensed and returned. Pharmacy tracking software can help perform these functions. In a well-integrated system, as a physician orders a medication, the EHR performs clinical checks (dose, allergy, drug interactions, etc) and releases it from a mechanized dispensary (e.g. Pyxis, Omnicell). At the same time, a message is sent to patient billing to charge for the medication and another message is sent to the pharmacy inventory computer to see if more drug has to be purchased from the manufacturer.

• 6. Scheduling. Scheduling software helps coordinate the activities of many providers and patients. It can also be used to create and distribute work schedules for nurses, providers and others.

• 7. Medical Staffing. A medical staff office may use a database to keep track of providers’ credentials, Continuing Medical Education, disciplinary actions, privileges, staff dues, insurance policies, office hours, languages spoken and other items.

• 8. Personal Health Record (PHR) . Patients often compile their own health records in the form of a PHR. PHR’s can be designed to receive information from other sources, such as personal fitness devices, community health information exchanges, immunization servers or EHRs.

• 9. Scanning and archiving. Documents that are not stored as structured data can be stored as scanned images. These documents may contain clinical information or may be any other kind of stored data, such as purchase orders or contracts.