Health Information Systems: Part 1

In today’s Health systems, the lines between Medical Devices and Information system are being blurred. What once may have been considered an IT system may now be an FDA cleared medical device. Asking the appropriate questions based on equipment quantities and vendor standards is not enough to fully deliver an accurate design and budget. Having a thorough knowledge of the different interconnecting systems and the flow within a healthcare environment helps to create an accurate picture of the full spectrum of services.

EMR and Data Flow

The first step in understanding Information systems is to understand the terminology and what services these systems provide. The center of all Information systems is the EMR or Electronic Medical Record. There is some confusion between the term EMR and EHR, Electronic Health Record. An EMR is the patient’s medical record within a health system while an EHR is the medical records of a patient that is based on information as they move from health system to health system. With the onset of Electronic Medical Records, it was necessary for redundant work, the charting of vitals into the EMR, to be replaced by automation. To communicate this information into the EMR from all the various medical device and communication systems there is a need for a server that can translate from the different programming languages to a common format. Terms like middleware, DAS, data acquisition system, and device connectivity are used interchangeably to describe software and hardware that is utilized to capture information from medical devices, nurse call alarms, beds, and communication devices. The common language to communicate between the medical device servers, medical devices, nurse call systems, and communication devices is HL-7 or Health Level 7. The middleware hardware consists of computers, servers, and data acquisition modules (sometimes referred to as dongles). Dongles are devices used to translate from RS-232 to TCP/IP or USB to TCP/IP. For example, a device that transmits the data across the serial port with have a dongle attached and this dongle will be assigned an IP address. Once an IP address is assigned to the dongle, the medical device can be placed on the hospital network. Some common vendors are CapsuleTech, Cerner’s CareAware iBus, ISirona, and in some instances the OEM’s of the medical devices will provide a common solution. Below is an example of how data flows from the medical device, in this instance patient monitoring, to the middleware and populates the EMR every 60 seconds.

Radiology Information Systems

There are several sub-systems within a health system that does not filter through the middleware but is a unique and separate system which feeds the data directly into the EMR but also is a separate application. Radiology Information Systems or RIS is a unique platform focused solely on Imaging and consists of several systems:

• Scheduling

• Modality Worklist – feeds data directly from the EMR to PACS and the Imaging equipment. This data includes patient name, time, procedure, medical record number, and demographics

• Billing

• Post Processing – software used to markup and clean-up images after the study which will be uploaded to PACS where it will be available to the Radiologist or Physician for review.

• PACS – Picture Archiving and Communication Systems – this is the server that attaches the image from the patient medical record and allows for the clinical team to review

• VNA – Vendor Neutral Archive – This is the long-term storage for Images, images are moved from PACS after a specific time, dependent on the reason for the scan, and moved to this archive

This is just a quick overview of typical information systems within the healthcare environment. All health systems are unique in the way they design and plan, but the language is very similar. Stay tuned for Part II which will dive into other modalities like Pharmacy, Lab, ADT, Billing Cycle, and Ancillary services.