Hospital Information System (HospitalInformationSystem, HIS) in the international academic community has been recognized as an important branch of the emerging medical informatics (MedicalInformatics). The United States in the field of the famous professor Morris Collen in 1988 has written for the hospital information system is defined as follows: the use of electronic computers and communications equipment, for the hospital belongs to the various departments to provide patients with diagnosis and treatment information and administrative information collection, storage, processing, extraction and data exchange capabilities, and to meet the functional needs of all authorized users.
[edit]Significance
Improve hospital management and support medical education and research.
China's hospital information processing basically remains in the manual mode, labor-intensive and low efficiency, physicians and nurses and managers of a large amount of time are consumed in transactional work, resulting in "people can not do their best"; patients waiting in line for a long time, the process of transferring a lot of influence on the order of the hospital; medical records, clinical tests, pathological examinations, and other valuable data retrieval is very laborious or even difficult to achieve; in-depth information on these materials, the search is very difficult to achieve, and even the search is very difficult. Even difficult to achieve; these data in-depth statistical analysis can not be carried out manually, can not be fully utilized for medical research; in the economic management of the phenomenon of leakage, running, wrong fee; hospital materials management due to inaccurate information, the bottom of the family is not clear, the waste of backlogs, so that "things can not be fully utilized". The development of HIS is an effective way to solve these problems, the effective operation of the HIS system will improve the efficiency and quality of the work of the hospital to promote medical research, teaching; reduce the labor intensity of various types of transactional work, so that they spare more energy and time to serve the patient; improve business management, plug the loopholes, to ensure that the patient and the hospital's economic interests; to create economic benefits for the hospital.
The complete HIS system realizes the whole process of tracking and dynamic management of information, so as to simplify the process of diagnosis and treatment of patients, optimize the environment, and change the current queuing more, waiting time is long, chaotic order of the situation. Such as most hospitals must be registered, waiting for medical records, pricing, charging, medicine or treatment of a series of processes, a patient is less than 3 times the queue, more than 5, 6 times, for the process of time at least in more than 1 hour, if the implementation of the HIS, each patient for the process of diagnosis and treatment of the intermediate process of time will be greatly reduced; assuming that the number of outpatient visits a hospital for 2,000 / day, annual outpatient clinic Assuming that the number of outpatient visits in a hospital is 2,000 per day, and the annual outpatient visits are 250 days, each person spends half an hour less, saving 1,000 hours per day and 360,000 hours per year, the social and indirect economic benefits are obvious. At the same time, the implementation of HIS also strengthens the internal management of hospitals, reduces the work intensity and time of medical staff, and solves the phenomenon of pseudo, counterfeit and leakage, and accelerates the turnover of funds and reduces the backlog of medicines, equipment and other materials. It is estimated that if 2,000 hospitals across the country to apply HIS, each year, each hospital to increase revenue and save money, accelerate the return of funds and turnover, plug the leakage, reduce the backlog of materials and the recovery of the capital side of the benefit of 200,000 yuan according to the estimate (the actual higher than this), then the annual benefit of the estimated 4 billion yuan, is very substantial. But this is often not recognized. Of course, the establishment of HIS is also more important in its long-term effects on hospital management, quality of care and medical research to bring comprehensive benefits. Therefore, the investment in HIS generally needs to be a basic investment, true as the statistical department of any institution, it is the department that spends money, but its importance is recognized, the investment is also necessary. the benefits of HIS far beyond the hospital itself, because the complete medical record of the patient is an important information resource for medical research, which is mostly abandoned in the manual work environment.
[edit]Domestic and foreign situation and development trend
(I) foreign developments
The application of electronic computers in hospitals has a history of more than thirty years, in the early 1960s, the United States began the study of HIS. The famous Massachusetts General Hospital & lt; MGH & gt; development of the COSTAR system is the beginning of the 60's and developed into today's large-scale clinical patient information system. With the development of computer technology, the 70's, HIS into a period of great development, the United States, Japan and Europe, hospitals, especially university hospitals and medical centers have developed HIS, become the basis for the formation and development of medical informatics. 70-80's, the United States of America's HIS industry has been a great development.
The 1985 U.S. National Hospital Data Processing Survey showed that more than 100 beds in the hospital, 80% of the realization of the computerized financial charge management, 70% of the hospital can support the patient registration and administrative affairs management. 25% of the hospital has a more complete HIS, that is, the realization of the ward medical staff directly with the computer to deal with the doctor's orders and query the test results of the laboratory. 10% of hospitals (2530) have a fully computerized HIS.
HIS development and application in Japan began in the early 1970s. Most Japanese hospitals started their HIS efforts after the 1980s, but the development was very rapid and quite large, with mainframe-centered hospital computer systems. For example, Kitasato University Hospital's IBM/3090 dual-computer system. Currently the general trend of Japan's HIS is systematic, networked, comprehensive, began to take the top-down development route, generally have a mainframe as the center, support the work of the entire system, and try to use microcomputer and network technology, the scale of the investment is large, is the realization of the "ordering" way of working, that is, data from the source directly into the computer. By 1991, nearly 10 hospitals had realized or basically realized this mode of operation. Functionality in support of diagnosis and treatment is increasing, and the system operates 24 hours a day. A lot of software is jointly developed by hospitals and computer companies, and some large companies have also developed some general hospital information management software packages, and some hospitals have developed their own. Kitasato University, for example, developed a comprehensive HIS at a development cost (excluding machinery and equipment) of 340 million yen (about 13 million yuan). Daily running cost expenditure is 510 million yen a year (about 20 million yuan).
The development of HIS in Europe is a little later than the United States, most of which began in the mid-1970s and 1980s. European HIS is characterized by the realization of a number of regional information systems. For example, RedSystem in Denmark, which manages 76 hospitals and clinics. France's Eighth Healthcare Center has realized an integrated information system - GrenobleIntegratedHIS - capable of managing three major hospitals and three medical colleges.With the development of primary health care, regional hospital computer networks will be realized in various European countries. At present the European **** body of SHINE project & lt; StrategicHealthInformaticsNetworkforEurope> has begun, Britain, France, Italy and Germany many companies are involved in this project. A great deal of work has been done on distributed database systems and open net engineering. In the early 80's, with the appearance of Apple PC and the popularization of BASIC language, some hospitals started to develop some small management software, such as payroll software, etc. In the mid-80's, with the appearance of XT286 and localization, as well as the appearance of DBASEIII and UNIX network operating system, some hospitals started to set up a small local area network, and developed small network based on the departmental management. management system, such as hospitalization management, pharmacy management and so on. Into the 90's, NOVELL network and FOXBASE, FOXFRO database is increasingly prevalent, the realization of a complete hospital network management system has become possible, so some of the computer technology strength of the hospital began to develop hospital management system suitable for their hospitals. Some computer companies are not the right time to develop HIS, such as Dalian Huiyuan Electronic Systems Engineering Company Limited (in cooperation with 301 Hospital), IBM, Microsoft, Wave. However, these systems are the following problems:
1. software level is low, generally can only do some primary transaction processing, there are also software development after a period of time to stop, do not go on, the reasons are:
(1) the lack of computer professionals in the hospitals, the technical force is weak, in particular, the lack of high-level systems analysts and interdisciplinary composite talent.
(2) Many projects, scattered strength.
(3) Limited hospital funds, it is difficult to establish the ideal software and hardware support environment.
2. Duplication of development. According to a provincial survey, over the past few years, the total **** development of 262 projects, the payroll system on 41, 21 medical statistics, 21 personnel ......, the duplication rate of more than 70%, the reasons for this:
(1) the unit management style has a certain degree of difference, the software can not be universal.
(2) software does not have a unified standard, it is difficult to promote.
(3) The country does not have a higher level of hospital management software package that can be widely promoted.
[edit]Complete Hospital Information System
(I) Hospital Management Information System and Clinical Information System
The main goal of the HospitalManagementInformationSystem (HMIS) is to support the hospital's administrative and transaction processing business, reduce the labor intensity of the transaction processing staff, and assist the hospital's administrative and transaction processing staff. The main goal of HMIS is to support the hospital administration and transaction processing business, reduce the labor intensity of the transaction processing staff, assist hospital management, assist senior leadership decision-making, improve the efficiency of the hospital, so that the hospital can be less investment to obtain better social and economic benefits, such as the financial system, personnel system, inpatient management system, drug inventory management system belongs to the scope of the HMIS.
Clinical information system (ClinicalInformationSystem, CIS) main goal is to support the clinical activities of the hospital medical staff, collect and process the patient's clinical medical information, enrich and accumulate clinical medical knowledge, and to provide clinical consultation, assisted diagnosis and treatment, assisted clinical decision-making, improve the efficiency of the work of the medical staff, and to provide more, faster and better service for patients. It can improve the efficiency of medical and nursing staff and provide more, faster and better services for patients. Like the doctor's order processing system, patient bedside system, doctor's workstation system, laboratory system, drug counseling system and so on belong to the scope of CIS.
A complete hospital information system (IntegratedHospitalInformationSystem, IHIS) should include both hospital management information systems, including clinical medical information systems, which is no doubt.
The hospital management information system requires fewer resources, compared to the required disk capacity, the number of workstations, network transmission capacity, the quality of the display are far lower than the needs of CIS.
The computer technology to support a hospital management information system is relatively pure and simple. As the hospital management information system to deal with text and digital data, less involved in sound, graphics, multimedia data, such as dynamic transmission of complex needs, so much easier to realize.
Clinical information systems in the real-time requirements of data processing, response speed, security and confidentiality are generally more demanding than management information systems.
From the input and output considerations, most hospital decision makers believe that HMIS than CIS, can make the hospital more direct, more obvious, and more rapid return on the system. That is to say, with less investment, to obtain a greater return.
Of course, HMIS and CIS are not diametrically separated, HMIS often involves some of the patient's clinical information, especially its collection of the patient's main index, the first page of the case, and other information is often the basis of the CIS patient-centered clinical medical information. And once CIS is established, it also tends to make HMIS work more accurately and efficiently.
(ii) the three levels of computer information processing
The complete hospital information system can be roughly divided into three different levels of information processing: the data collection process; centralized processing of data, processing and analysis of the process and decision-making consulting and decision support process. Generally speaking, the data collection process is linked to the grass-roots departmental activities; centralized data processing and analysis process is linked to the middle level of the department's work tasks; decision-making, support process is linked to the senior leadership.
1. Support for online transactions
Usually, the flow of information is accompanied by a variety of window business processes occur, these window business processes may be hospitals, financial and material administrative operations, may also be related to outpatient, emergency patients, inpatient medical affairs. For example: the personnel department should handle the adjustment and change of hospital staff salary; the general affairs department should be responsible for the supply, purchase and distribution of supplies, materials, office supplies and low-value consumables for all departments of the hospital; the doctors in the wards should constantly issue medical prescriptions for the inpatients; the nurses should constantly organize the medical prescriptions or all kinds of medication lists, medication lists, injection lists, treatment lists, laboratory tests and check lists, and implement and record the implementation of the process; and the pharmacy pharmacist in the outpatient clinics. The outpatient pharmacy pharmacist has to price the prescription, to dispense and issue medication to the patient; the outpatient fee office has to complete the business of price charging, in a variety of prescriptions, laboratory tests, checklists stamped with the charge mark and pay the patient's bill (reimbursement form). In the process of all these complicated and trivial business activities, a large amount of information is generated. We developed the HIS to support these routine, high-volume front-office transactions. Transaction-level computer systems (e.g., outpatient billing systems, ward order processing systems, etc.) should be dual-tasked at the same time.
For window clerks, these systems are the tools that help them accomplish the daily grind of window operations. With the help of computer systems, their messy work becomes organized, relieving them of the need to memorize a lot of information (specifications, prices of medicines, names and codes of diseases, etc.). Ensuring that they comply with certain norms relieves them of the burden of summarizing, counting, reporting, and transmitting this information. Therefore, as far as possible in line with the working order and work habits of these transaction level staff, functional integrity, simple operation, rapid response, friendly interface, easy to learn and easy to use as such software must meet the functional requirements. Users should feel that the system is designed specifically to help them complete the window business. The system has any other function (refers to support for window business processing outside the function) should try to be background, hidden, not perceived by the end-users, do not increase or minimize the increase in the burden of window business processors.
For the entire hospital information system, the window processing computer system is also a complete HIS data collection port. They are the tentacles, receptors of the HIS reaching out to the origin of the information. For example: for patients in and out of the transfer (ADT) business system is bound to provide real-time information to the hospitalization of patients in and out of the transfer of information, but also is the main source of information on the dynamic statistics of hospitalized patients. Outpatient charging system in the completion of the patient payment process at the same time also collected the corresponding outpatient medical services for the outpatient clinic to provide medical services to the outpatient departments and auxiliary departments of the outpatient revenue and workload information. All these data are the raw materials for statistical, analytical and other data processing in the upper level and up to the highest level of information systems. From the point of view of data collection, HIS requires the window business system to collect information is complete, accurate, timely and secure.
2. Support the summary and analysis of section-level information
The hospital's middle section is responsible for heavy management tasks, for example, the Medical Department is responsible for the hospital's medical work planning, organization and implementation, supervision and control of medical dynamics, medical quality inspection and management; Personnel Department is responsible for the hospital's organizational setup and adjustments, attendance and assessment, all levels of various types of professional and technical positions of the assessment; Nursing Department is responsible for the organization and implementation of the hospital's nursing work, the organization and implementation of the nursing work, and the management of the nursing department. The Nursing Department is responsible for the organization and implementation of the hospital's nursing work, the management of the hospital's nursing quality, the management of nursing staff ...... and so on. With these management-level work increasingly scientific, middle-level departments will increasingly rely on them from the grass-roots level to collect basic data for aggregation, statistics and analysis, used to evaluate their management of grass-roots departments and individual work, according to plan, supervise the implementation of the report and make decisions.
The computerized information system should support the middle level of data collection, synthesis, aggregation, analysis, reporting and storage. Section-level information systems should be able to automatically collect data from the primary section on a regular basis, process the data in various ways as needed, and produce categorized statistical reports and reports that support the management of the middle section. For example, the statistics office should be able to collect patient ADT data from the inpatient service, patient charge data from the billing service, and clinical data about inpatient diagnosis and surgery from the case room, and produce regular reports on inpatient dynamics, bed utilization, and single-medicine analysis. The medical department should collect relevant information from the hospitalization department, statistics office, wards, operating rooms and other departments to produce various reports on medical dynamics and medical quality control.
Information systems at the departmental level are characterized by:
Usually not connected to the window processing.
There are fewer real-time data entry tasks.
Information collected is processed on a regular basis.
The processing algorithms are usually fixed.
The purpose is to manage the business needs of the department or for regular reporting and reporting.
3. Support for the top leadership of the hospital on the demand for management information
The top leadership of the hospital to achieve the scientific management of the hospital must be fully supported by the computer information system. After the middle-level departments to process and analyze the data not only to produce the output of the statements and reports submitted to the senior leadership to directly assist the hospital's top leadership in decision-making, but also through the computer's information system to the processed data directly to the highest level of leadership. HIS of the highest layer of modules: medical and financial information of the integrated query and decision-making module to receive and re-organize these data, the hospital's various functions, including clinical, administrative, health care, and decision-making module to the hospital, the hospital's various functions. Including clinical, administrative, medical and financial aspects, the information of various departments along the two main lines - medical and financial combination, to provide some very convenient and flexible means of retrieval and query, to meet the top leadership of the hospital's ever-changing needs for information of all kinds. This layer of information systems is characterized by:
It is not connected to any specific transaction processing, that is, in addition to receiving data from the lower levels and make a variety of inquiries, statistical requests, there is no data entry.
Its main function is to provide flexible retrieval, query, statistics, analysis capabilities.
The output of this system is reports and reports that are demand-driven, irregular, and without fixed content.
The system is often associated with a number of financial management, economic accounting, quality control, dynamic analysis, and other specialized models and algorithms related to hospital management. For example, monitoring and evaluation of medical quality, monitoring and evaluation of hospital financial performance, monitoring and evaluation of the burden of medical workload in various departments, and so on.
The system emphasizes that the form of reports generated, such as graphs, charts ...... and so on, should be flexible, popular and easy to understand.
[edit]Characteristics
Broadly speaking, a hospital management information system is a specific application of a management system (MIS) in a hospital environment. Therefore, it must have some of the following characteristics with other MIS systems***:
They are database as the core, to the network as the technical support environment, with a certain scale of computerized systems
They are to operate the business as the main line of business to improve the quality and efficiency of the work and auxiliary decision-making for the main purpose, can improve the level of integrated management, reflecting the overall picture of the enterprise, enhance the competitiveness of the enterprise, and obtain more information, and to improve the quality and efficiency of the work. Enhance the competitiveness of enterprises, to obtain more and better social and economic benefits of the information system
In the system is divided into a number of subsystems in accordance with certain principles (may also be a layer of subsystems on top of the subsystems), subsystems, subsystems, interfaces with each other, can be effectively exchanged information, the real realization of the information resource **** enjoy
The object of the processing of the structured data, also semi-structured or non-structured. There are also semi-structured or unstructured data. Some data and structure will be more affected by human intervention and social factors, that is, there are static and dynamic
Development is difficult, technically complex, long cycle
With a perfect system management, supervision, operation and guarantee system, as well as the corresponding regulations and system security measures. Hospital information system belongs to the world's existing enterprise-level (Enterprise) information systems in the most complex category. This is the hospital's own goals, tasks and nature of the decision. It should not only be the same as all other MIS systems to track and manage the accompanying human, financial and logistical flow of management information generated to improve the operational efficiency of the entire hospital, but also to support the patient's medical information records as the center of the entire medical, teaching and research activities. The complexity of the system is manifested in:
In many cases, it requires extremely rapid response time and online transaction processing capabilities. When an emergency patient is admitted to the hospital for resuscitation, the importance of obtaining their past medical history and medical records quickly, promptly, and accurately is obvious. When the outpatient hall is crowded with hundreds of patients and their families at peak hours every day, anxiously waiting in line for registration, waiting for treatment, price, payment, and medicine, the system requirements for OLTP can be said to be no less than any bank window business systems, airline ticket booking and sales systems.
Medical information complexity. Patient information is expressed in a variety of data types, not only the need for text and data and often graphs, charts, images and so on.
Information security and confidentiality requirements are high. Patient medical records are a legally binding document, not only in the case of medical disputes, but also in many other legal procedures will play an important role in the personnel, financial, and even the patient's medical information are strictly confidential.
Large amount of data. Any patient's medical record is a growing, richly illustrated book, and it is common for a large general hospital to have millions of patient records.
Lack of standards for medical information processing. This is another issue that prominently complicates the development of hospital information systems. There are very few standards and specifications for medical information representation, hospital management models, and information system models in the healthcare community. Computer professionals in the process of developing information systems have to spend a great deal of effort to deal with the standardization of information in areas with which they are not familiar, and even to participate in the development of some hospital management models and algorithms. The standardization of the expression of medical knowledge, i.e. how to translate medical knowledge into a form suitable for computers, is a worldwide problem. And the realization of the real patient electronic medical records pending the resolution of this problem.
The uncertainty of the hospital's overall goals, institutions, organizational structure, management methods, and information flow patterns adds to the difficulty of analyzing, designing, and implementing an HIS. As we all know, China is currently in a reform, opening up to the great changes in the nature of hospitals, institutions, organizations, systems, management concepts, methods and means are changing, which greatly increases the difficulty of our HIS design.
High level of information **** enjoy the demand. A doctor's need for medical knowledge (such as the use and dosage of a new drug, contraindications, a particular case of literature and conclusions, etc.), the patient's medical records (whether the patient in the hospital or a number of years ago, the patient has died) may occur in all of his medical, teaching and research activities, which may occur in any location. The summary of an inpatient's hospital record (the contents of the first page of the case) may also be needed by all relevant clinical departments, medical and technical departments, and administrative departments (from the janitor to the director) throughout the hospital. Therefore, the information **** enjoyable design, information transmission speed and security, network reliability is also HIS must ensure.
The psychological and behavioral barriers of health care, management personnel. The success of the hospital information system depends on the involvement of hospital medical staff, managers. Medical staff and managers of the application of computer psychological and behavioral barriers often lead to the failure of a system. In China, the prevailing educational background, the popularity of computers, and the difficulty of entering Chinese characters make end-users adopt a more general and strong resistance to using computers. This requires system designers to put more effort into human-computer friendly design, better interfaces, more convenient help information, simpler operation methods, easier to learn and faster entry of Chinese characters, etc. This, in turn, increases the risk of system failure. This, in turn, increases the overhead and complexity of the system.
Therefore, in view of the uniqueness of the hospital environment, the realization of the information system in the hospital should have its own special functional requirements:
To have a large-scale, high-efficiency database management system support
To have a strong on-line transaction processing (OnLineTransactionProcessing, OLTP) to support capacity.
Typical 7 days / 24 hours non-stop system, absolutely require security, reliability
Easy to learn and use the friendly human-machine interface
Tailorability and scalability, to adapt to the needs of different hospitals' development plans
Openness and portability, to adapt to different hard- and software platforms
Modular structure, expandability
[edit]Architecture
Currently, there are no more than three architectures available for an HIS to choose from, host plus terminal time-sharing system, microcomputer network plus file server system and client/server system.
The mainframe-plus-terminal time-sharing system has been the basic choice in the development of general hospital information systems in the United States, Western Europe, and Japan since the 1970s through the late 1980s. Many successful and famous HIS have been developed based on such an architecture. This is known as the traditional centralized information management mainframe-based model. Although such a system can meet the needs of HIS in terms of the amount of data it can handle, its operational efficiency, its support for complete relational databases, and its overall availability of data, it has been increasingly criticized in theory in recent years, and has been strongly impacted by the Downsizing wave in practice. It is generally believed that such a centralized system of one-time investment is too large, the application system is too much tied to the manufacturer's software and hardware products, the loss of the system's openness, flexibility, scalability, clumsy software development tools to affect the speed of application development, can not be compared to the PC API and GUI technology to affect the quality of the application software development and the success rate. More and more information system executives believe that their centralized Mainframe-based HIS will not have a long life. The centralized systems built in the 1980s at many large hospitals in Japan have become a heavy burden to be discarded and left behind. Therefore, although the centralized HIS has had its former glory, but we in the mid-1990s when the design of China's hospital information systems, is not supposed to, and will not go back to the Western countries ten years, twenty years ago, the old way.
The microcomputer network plus file server system can be said to be the mainstream choice of today's Chinese hospital information system architecture. Chinese hospital computer applications have experienced a single microcomputer single-tasking, multi-microcomputer multi-tasking into the microcomputer network file server stage, should be recognized as a great progress. Microcomputer network support distributed processing, and directly inherited all the advantages of the PC system, the user can make full use of their CPU at the same time and can *** enjoy expensive external equipment, massive external memory, laser printers and plotters, but also to achieve multi-user data *** enjoy. In fact, there are a number of small and medium-sized hospitals in such a system structure based on the success of part of the realization of the HMIS. However, such a system may be able to assume the large hospital departmental level (such as financial services, human resources, or patient admissions, discharges, etc.) of the information management tasks, but the inherent shortcomings of such a structure will make it difficult to take up the burden of establishing the entire hospital's complete information system. This is because: