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Integrating specialized application systems into hospital information systems--obstacles and factors for success.

Hospital information systems are often huge and heterogeneous systems. To support physicians with their daily clinical work, application systems are developed which are dedicated to particular medical fields or tasks and which have to be integrated into the hospital information system. The integration process is quite complicated, because it makes the information system's infrastructure even more heterogeneous. We developed an application system for documentation and therapy planning in pediatric oncology (DOSPO) and we started to introduce it into the Department of Pediatric Oncology of Heidelberg University Hospital. The fact that DOSPO is developed as a universal system for nationwide use made the integration process more difficult. In any case, the introduction of specialized application systems has to be planned systematically in advance, regarding the prevailing information system's infrastructure, available resources and established processes. To simplify the integration process comprehensive electronic patient records for the future should be designed in a way that they can be enhanced easily by new clinical functions.

Child↗

Integration of hospital information systems, operative and peri-operative information systems, and operative equipment into a single information display.

The integration of disparate information systems in the operative environment allows access to information that is typically unseen or unused. Through a collaborative effort, a variety of information systems and surgical equipment are being integrated. This provides improved context-sensitive information display and decision support and improved access to information to improve workflow, safety and visualization of information that was previously unattainable.

Data Display↗

The rabies information system--a model for a common information system in human and veterinary medicine.

An information system is described in the field of rabies, which realizes the integration of information streams from human medicine as well as from veterinary medicine by help of computers. This rabies information system is based on a homogeneous and coordinated system of surveillance in connection with prophylaxis and control of rabies. It includes a modification of the case record, suggested by the WHO-Expert-Committee on Rabies. The aims of this rabies information system are: to make obvious the epizootiological situation with formation and change of foci, to show the epidemiological importance of special animals and to recognize the epidemiological situation. All this has to be fulfilled in an integrated system. Furthermore optimal treatment is guaranteed by express diagnostics and earliest possible special treatment of high-risk groups by the co-operation of human and veterinary medicine. The rabies information system was generally introduced in the GDR in 1970. It has proved to be practicable and effective especially by standardization of diagnostics, recording exposure of the patient, his treatment and partly automated evaluations of situation records and documentation of efficiency.

Animals↗

[Hospital information system--project of implementation of SAP information system at Sveti Duh General Hospital].

Nowadays, as medical and hospital institutions have been facing a growing need of a more efficient provision of healthcare services to patients, with simultaneous complete monitoring of the successfulness of business activities, integrated information systems appear as the logical choice for the support to hospital business processes. The integrated business information system implemented at Sveti Duh General Hospital is a comprehensive system that supports all hospital, clinical and administrative processes, while providing the basis for decision making regarding the patients and hospital management. The system also enables transfer of all data with specific medical business segments such as laboratory device management. The project for the implementation of the information system was realized in accordance with the requests from the Ministry of Health, applying the proven methodology for the execution of such complex projects. The project team consisted of a number of consultants from b4b Co. from Zagreb, as well as Hospital employees. The new information system is completely ready for going live; however, the necessary decisions have to be made first. The application of the system gives the medical staff more time for their professional work with patients, and through longterm collection and analysis of data on symptoms, illnesses and medical treatments, the information system becomes an important tool for the improvement of health and quality of healthcare system in general.

Clinical Laboratory Information Systems↗

Nursing Information System.

Nursing Information System (NIS) is a part of a health care information system that deals with nursing aspects, particularly the maintenance of the nursing record. The several objectives that a Nursing Information system should meet in order to succeed its aims, cover the users' needs and operate properly are described. The functions of such systems, which combine with the basic tasks of the nursing care process, are examined. As Nursing Information System is part of the health care and hospital information system, the different strategies and approaches for designing and developing Hospital Information Systems followed from the decade of 1970 until the recent decade of 1990, are presented. The three main approaches followed were the "centralized approach", the "departmental approach", and the "distributed approach". The advantages and drawbacks of each different approach are examined. For the implementation or upgrade of Nursing Information System a NIS committee comprised by different health care professionals, is necessary to be formed. The implementation and upgrade of a Nursing Information System follows some specific phases. These steps, include planning phase, analysis phase, design phase, development phase, implementation phase, and upgrade phase. A paragraph at the end of this chapter summarizes the future trends of Nursing Information Systems.

Health Plan Implementation↗

The National Institutes of Health Clinical Center Digital Imaging Network, Picture Archival and Communication System, and Radiology Information System.

In this work, we describe the digital imaging network (DIN), picture archival and communication system (PACS), and radiology information system (RIS) currently being implemented at the Clinical Center, National Institutes of Health (NIH). These systems are presently in clinical operation. The DIN is a redundant meshed network designed to address gigabit density and expected high bandwidth requirements for image transfer and server aggregation. The PACS projected workload is 5.0 TB of new imaging data per year. Its architecture consists of a central, high-throughput Digital Imaging and Communications in Medicine (DICOM) data repository and distributed redundant array of inexpensive disks (RAID) servers employing fiber-channel technology for immediate delivery of imaging data. On demand distribution of images and reports to clinicians and researchers is accomplished via a clustered web server. The RIS follows a client-server model and provides tools to order exams, schedule resources, retrieve and review results, and generate management reports. The RIS-hospital information system (HIS) interfaces include admissions, discharges, and transfers (ATDs)/demographics, orders, appointment notifications, doctors update, and results.

Hospital Information Systems↗

[Application of global positioning system and geographic information system in surveillance of schistosomiasis].

OBJECTIVE: To use the snail survey data of Yugan, Jiangxi Province as an example to evaluate the effects and advantages of global positioning system integrated with digital maps and remote sensing data in order to manage and analyze the whole country's surveillance data of schistosomiasis by using geographic information system. METHODS: The data of geographic information and snail information of 20 marshlands in Yugan, Jiangxi Province were collected, and by the correction of remote sensing images based on the digital maps and index extraction, the snail current situation and trend were analyzed and expressed. RESULTS: A series of specific procedure images of these 20 marshlands was established and the effects of Yugan surveillance platform based on geographic information system were validated. CONCLUSION: The whole country's surveillance data of schistosomiasis might be successfully integrated with geographic information system by global positioning system and be managed and expressed, which supplies a successful platform in using the surveillance data effectively.

Animals↗

Computerized nursing system in hospital information system.

We have developed a computerized nursing system including a nursing information system, a nursing administration system and a nursing support system. This on-line nursing system is linked to the total hospital information system. This paper describes the purpose and concept of the system development. The nursing system can be utilized in the individualized planning, delivery and evaluation of patient care.

Data Display↗

Expert systems integrated with information systems.

Amongst the users of the AIDA applications there is a rapidly growing interest in the use of expert systems, not as independent systems, but as logical extensions of their already existing information systems. In this paper a prototype system (IDEA) will be described that consists of a set of utilities for the construction of an expert system within the context of an AIDA application. Although IDEA does not excel in sophisticated knowledge representations nor in search strategies (the development of which was not our primary concern) it is able to demonstrate that the facilities provided by AIDA together with the IDEA facilities result in an expert system which is characterized by a high degree of integration with the already operational information system.

Artificial Intelligence↗

A synthesis of a vocational assessment system and an information system of technical aids.

PURPOSE: In vocational rehabilitation, the selection and tailoring of the work place is tightly bound with the integration or reintegration of people with disabilities into the work environment. Instruments which ease this task are assessment systems as well as information systems of technical aids. To date, these instruments are separated from one another in practice. They also necessitate a broad transfer capacity between the results of an assessment system and the selection of technical aids for a work place design suited for people with disabilities. METHOD/RESULTS: Therefore, when employing assessment system, immediate access to information concerning technical aids would ease the work of experts in the area of vocational rehabilitation. This information should also provide a commentary concerning which aids have been utilized to date in concrete cases of suitably designing work places for people with disabilities. CONCLUSIONS: This article describes the synthesis of a vocational assessment system with an information system of technical aids from the aspect of frequency of use.

Communication Devices for People with Disabilities↗

[ISA--Information System Anesthesia. Decision support by a computer-based information system].

"ISA"-Information System Anesthesia-will support the anesthesiologist by presenting information concerning the anesthesia approach. In addition to computing patient data (monitoring), there are three special fields where computers are used in anesthesia: (1) simulation systems for anesthesia training (preventing critical incidents); (2) critiquing systems to comment on the planned anesthesia decisions; and (3) reference systems for rapid information gathering. Simulation and critiquing systems are mainly useful for personal training. Reference systems present information concerning the anesthesia problems to aid in decision-making. ISA is a reference system designed to support the decision process for neurosurgical operations; a new method of presenting information by personal computer in the surgical working area. For each neurosurgical operation there is a graduation of condensed and detailed information with the option of also obtaining general anesthesia knowledge.

Anesthesiology↗

Making the transition from information systems of the 1970s to medical information systems of the 1990s: the role of the physician's workstation.

Many hospitals today have implemented widely disparate information systems on mainframe and mini-computer hardware. The advent of network technology in hospitals has made it possible to access information in these systems. Unfortunately, the user interfaces to applications on these systems are unique and difficult to learn, which makes them unsuitable for use by clinical services. In this paper we describe the development of a Physician's Workstation which integrates information from multiple existing information systems and discuss how the workstation makes it possible to move from the departmental systems of the present to the computer-based medical record system of the future.

Computer Communication Networks↗