Building a Comprehensive Clinical Information System from Components

P.D. Clayton; S.P. Narus; S.M. Huff; T.A. Pryor; P.J. Haug; T. Larkin; S. Matney; R.S. Evans; B.H. Rocha; W.A. Bowes III; F.T. Holston; M.L. Gundersen

doi:10.1055/s-0038-1634203

Methods of Information in Medicine, Inhaltsverzeichnis

Methods Inf Med 2003; 42(01): 01-07
DOI: 10.1055/s-0038-1634203

Original article

Schattauer GmbH

Building a Comprehensive Clinical Information System from Components

The Approach at Intermountain Health Care

P.D. Clayton

¹Intermountain Health Care, Salt Lake City UT, USA, USA

²University of Utah, USA

,

S.P. Narus

¹Intermountain Health Care, Salt Lake City UT, USA, USA

²University of Utah, USA

,

S.M. Huff

¹Intermountain Health Care, Salt Lake City UT, USA, USA

²University of Utah, USA

,

T.A. Pryor

¹Intermountain Health Care, Salt Lake City UT, USA, USA

²University of Utah, USA

,

P.J. Haug

¹Intermountain Health Care, Salt Lake City UT, USA, USA

²University of Utah, USA

,

T. Larkin

¹Intermountain Health Care, Salt Lake City UT, USA, USA

,

S. Matney

¹Intermountain Health Care, Salt Lake City UT, USA, USA

,

R.S. Evans

¹Intermountain Health Care, Salt Lake City UT, USA, USA

²University of Utah, USA

,

B.H. Rocha

¹Intermountain Health Care, Salt Lake City UT, USA, USA

²University of Utah, USA

,

W.A. Bowes III

¹Intermountain Health Care, Salt Lake City UT, USA, USA

,

F.T. Holston

¹Intermountain Health Care, Salt Lake City UT, USA, USA

,

M.L. Gundersen

¹Intermountain Health Care, Salt Lake City UT, USA, USA

› Institutsangaben

Abstract

Summary

Objectives: To discuss the advantages and disadvantages of an interfaced approach to clinical information systems architecture.

Methods: After many years of internally building almost all components of a hospital clinical information system (HELP) at Intermountain Health Care, we changed our architectural approach as we chose to encompass ambulatory as well as acute care. We now seek to interface applications from a variety of sources (including some that we build ourselves) to a clinical data repository that contains a longitudinal electronic patient record.

Results: We have a total of 820 instances of interfaces to 51 different applications. We process nearly 2 million transactions per day via our interface engine and feel that the reliability of the approach is acceptable. Interface costs constitute about four percent of our total information systems budget. The clinical database currently contains records for 1.45 m patients and the response time for a query is 0.19sec.

Discussion: Based upon our experience with both integrated (monolithic) and interfaced approaches, we conclude that for those with the expertise and resources to do so, the interfaced approach offers an attractive alternative to systems provided by a single vendor. We expect the advantages of this approach to increase as the costs of interfaces are reduced in the future as standards for vocabulary and messaging become increasingly mature and functional.

Keywords

HELP - IHC - CDR

Volltext

Referenzen

References
1 Leguit F. Interfacing Integration in Hospital information systems:Scope-Design-Architecture. Bakker AR, Bryant JR, Ehlers CT, Hammond WE. eds. North Holland, Amsterdam: 1992. pp 141-8.
2 Slack WV, Bleich HL. The CCC system in two teaching hospitals: a progress report. Int J Med Inf. 1999; 54 (Suppl. 03) 183-96.
3 Scherrer JR, Baud RH, Hochstrasser D, Ratib O. An integrated hospital information system in Geneva. MD Comput. 1990; 7 (Suppl. 02) 81-9.
4 Collen MF. A brief historical overview of hospital information system (HIS) evolution in the United States. Int J Biomed Comput. 1991; 29 (3-4) 169-89.
5 Anderson CL, Meldrum KC. The VA computerized Patient Record – a first look. Proc Annu Symp Comput Appl Med Care. 1994: 1048.
6 Overhage J, McDonald CJ, Suico JG. The REGENSTRIEF medical record system 2000: Expanding the breadth and depth of a community wide EMR Proc AMIA Symp. 2000: 1173.
7 Pryor TA, Gardner RM, Clayton PD, Warner HR. The HELP system. J Med Syst. 1983; 7 (Suppl. 02) 87-102.
8 Tolchin SG, Stewart RL, Kahn SA, Bergan ES, Gafke GP, Simborg DW, Chadwick MG, Whiting-O’Keefe QE. A prototype generalized network technology for hospitals: initial implementation. J Med Syst. 1982; Aug 6 (Suppl. 04) 359-75.
9 Simborg DW. The case for the HL7 standard. Comput Healthc. 1988; Jan; 9 (Suppl. 01) 39-40-2.
10 Scherrer JR, Spahni S. Healthcare information system architecture (HISA) and its middleware models. Proc AMIA Symp. 1999: 935-9.
11 Chu S, Cesnik B. A three-tier clinical information systems design model. Int J Med Inf. 2000; 57 2-3 91-107.
12 Van de Velde R. Framework for a clinical information system. Int J Med Inf. 2000; 57 (Suppl. 01) 57-72.
13 Lowe HJ, Buchanan BG, Cooper GF, Vries JK. Building a medical multimedia database system to integrate clinical information: an application of high-performance computing and communications technology. Bull Med Libr Assoc. 1995; 83 (Suppl. 01) 57-64.
14 Greenes RA. A “building block” approach to application development for education and decision support in radiology: implications for integrated clinical information systems environments. J Digit Imaging. 1991; 4 (Suppl. 04) 213-25.
15 Glaser JP, Beckley 3rd RF, Roberts P, Marra JK, Hiltz FL, Hurley J. A very large PC LAN as the basis for a hospital information system. J Med Syst 1991; 15 (Suppl. 02) 133-7.
16 Clayton PD, Sideli RV, Sengupta S. Open architecture and integrated information at Columbia-Presbyterian MedicalCenter. MD Comput. 1992; 9 (Suppl. 05) 297-303.
17 Clayton PD. Current developments and future trends in Information technology in health care in Hospital Information Systems:Scope-Design-Architecture. Bakker AR, Bryant JR, Ehlers CT, Hammond WE. eds North Holland, Amsterdam: 1992. pp 19-25.
18 Tarczy-Hornoch P, Kwan-Gett TS, Fouche L, Hoath J, Fuller S, Ibrahim KN, Ketchell DS, LoGerfo JP, Goldberg HI. Meeting clinician information needs by integrating access to the medical record and knowledge resources via the Web Proc AMIA Symposium. 1997: 809-13.
19 Ferrara FM. The CEN healthcare information systems architecture standard and the DHE middleware. A practical support to the integration and evolution of healthcare systems. Int J Med Inf. 1998; 48 1-3 173-82.
20 Van Mulligen EM, Timmers T, Brand J, Cornet R, van den Heuvel F, Kalshoven M, van Bemmel JH. HERMES: a health care workstation integration architecture. Int J Biomed Comput. 1994; 34 1-4 267-75.
21 Patil RS, Silva JS, Swartout WR. An architecture for a health care provider’s workstation. Int J Biomed Comput. 1994; 34 1-4 285-99.
22 Huff SM, Rocha RA, Bray BE, Warner HR, Haug PJ. An event model of medical information representation. J Am Medical Informatics Ass 1995; 2 (Suppl. 02) 116-28.
23 Huff SM, Rocha RA, Solbrig HR, Barnes MW, Schrank SP, Smith M. Linking a medical vocabulary to a clinical data model using Abstract Syntax Notation 1. Methods Inf Med 1998; 37 4-5 440-52.
24 Rocha RA, Huff SM. Development of a template model to represent the information content of chest radiology reports. Medinfo. 2001; 10 Pt 1 251-5.
25 Rocha RA, Huff SM, Haug PJ, Warner HR. Designing a Controlled Medical Vocabulary Server: The VOSER Project. Computers and Biomedical Research. 1994; 27 (Suppl. 06) 472-507.
26 Wilcox A, Narus SP, Bowes III WA. Using natural language processing to analyze physician modifications to data entry templates. Proc 2002 AMIA. Kohane I. ed. Hanley and Belfus 2002 pp 899-903.
27 Reichert JC, Glasgow M, Narus SP, Clayton PD. Using LOINC to link an EMR to the pertinent paragraph in a structured reference knowledge base. Proc 2002 AMIA. Kohane I. ed. Hanley and Belfus 2002 pp 652-6.
28 Cimino JJ, Socratous SA, Clayton PD. Internet as clinical information system: application development using the World Wide Web. J Am Med Inform Assoc. 1995; 2 (Suppl. 05) 273-84.