Daily Treatment Planning with an On-Line Shared Computer System

Operating within a larger medical information system (MIS), clinical support information systems (CSISs) process the specialized subsystem information used in support of the direct care of patients. Most of these CSISs were developed as stand-alone systems. This chapter highlights the early efforts to combine data from disparate departmental data systems into more "integrated ones" that support the full spectrum of data management needs of multi-hospital and ambulatory health systems. In the 1960s and 1970s, institutions incorporated clinical laboratory and medication subsystems into their MISs; more subsystems were added (pathology, imaging, etc.); and systems with integrated CSIS were developed for ambulatory care settings. Despite all the progress made over the past 40 years, two key challenges remain unsolved: fi rst is the lack of data interoperability among myriad systems; second is the lack of a useful point of care system. Both threaten to make the clinician's work harder; overcoming them is key to transforming the health care system. Keywords Clinical support information system s • Integrated CSIS • Interoperability • Point of care system s • Clinical subsystem s • Dietary information system sTaking care of a patient in 1950 or 2010 usually involved a physician seeing the patient in a medical offi ce or in a hospital. To evaluate the patient's health status, the physician took a history of the patient's medical problems (symptoms), performed a physical examination to discover any physical abnormalities (signs), and combined the symptoms and signs to see if they fi tted any syndrome. He then recorded the patient's history and examination fi ndings and any preliminary impressions of any syndromes in the patient's medical record, which was usually a paper-based chart. The physician often referred the patient for tests and procedures that involved clinical laboratory, radiology, and other clinical support services. Upon reviewing the results from these services, the physician could make a preliminary diagnosis

Section: Examples Of Early Csis and Integration With Mismentioning

confidence: 99%

Clinical Support Information Systems (CSISs)

Collen¹,

Silva²

2015

“…In 1968 physicians' orders began to be entered into their medical information system; and appropriate displays were accessed on IBM 2260 cathode-ray-tube terminals located in various clinical departments [ 12 ]. In 1969 using these display terminals connected to the Baylor University IBM/360 computer, updated reports were batch-processed daily for each patient [ 68 ]. By the mid-1970s, TIRR had an information system with several operational modules, including the provision of results of all patients' laboratory and functional capacity tests [ 197 ].…”

Section: Physical Medicine and Rehabilitationmentioning

confidence: 99%

Information Systems for Clinical Subspecialties

Collen¹,

Lorenzi

2015

Some of the earliest applications of computers in clinical medicine were in the clinical subspecialties, including cardiology, pulmonary, nephrology, gastroenterology, pediatrics, and the surgical sciences. But health professionals found these prototypes diffi cult to use; data entry devices were awkward and ineffi cient, and order entry functions were often not integrated. Each information system for a clinical subspecialty (ISCS) evolved differently, with its own specialized functional and technical requirements. In the 1960s mainframe computers were limited in their ability to meet all the processing requirements of all the ICSCs in a large hospital. By the 1970s each ISCS could have its own minicomputer-based system linked directly to the central mainframe. Health care professionals used terminals connected to the central computer to enter orders and to receive test results; the central computer transferred the orders to the appropriate ISCS subsystems and integrated the data coming back from the ISCSs into the patients' records stored in the mainframe computer. In the 1980s local area networks linked multiple lower-cost minicomputers; with distributed minicomputers and interactive visual display terminals, clinicians could begin to benefi t from the ISCSs in direct patient care and each ISCS could develop its own system to meet its own requirements. In the 1990s distributed information systems allowed physicians to enter orders and retrieve test results using clinical workstations connected to client-server minicomputers in the local area network that linked the entire hospital, and patient data from all of the distributed ISCS databases were integrated in a computer-based patient record.

“…It used eight IBM CRT visual display terminals connected to the Baylor IBM/360 computer. It scheduled an average of 30 patients (54 % of the hospital's inpatients) for physiotherapy and occupational therapy daily; and generated updated reports for each patient [ 63 ]. In 1970, TIRR initiated its pharmacy information system.…”

Section: Texas Institute For Rehabilitation and Research (Tirr)mentioning

confidence: 99%

The Early History of Hospital Information Systems for Inpatient Care in the United States

Collen¹,

Miller

2015

In the 1960s, large hospital systems began to acquire mainframe computers, primarily for business and administrative functions. In the 1970s, lower-cost, minicomputers enabled placement of smaller, special purpose clinical application systems in various hospital departments. Early time-sharing applications used display terminals located at nursing stations. In the 1960s and 1970s, a small number of pioneering institutions, many of them academic teaching hospitals with federal funding, developed their own hospital information systems (HISs). Vendors then acquired and marketed some of the successful academic prototypes. In the 1980s, widespread availability of local area networks fostered development of large HISs with advanced database management capabilities, generally using a mix of large mini-and microcomputers linked to large numbers of clinical workstations and bedside terminals. When federal funding for HIS development diminished in the mid-1990s, academic centers decreased, and commercial vendors increased their system development efforts. Interoperability became a main design requirement for HISs and for electronic patient record (EPR) systems. Beyond 2010, open system architectures and interconnection standards hold promise for full interchange of information between multi-vendor HISs and EPR systems and their related subsystems.In 1962, the American Hospital Association surveyed more than 7,000 registered hospitals regarding their usage of computer data processing applications. They found that only 7 % of hospitals used data processing equipment. Fewer than 1 % of smaller hospitals (<100 beds) used computer data processing, and 33 % of larger hospitals (at least 500 beds) used it. Among hospitals with electronic data processing capabilities, 63 % used it for payroll, 53 % for inventory control, and 44 % for patient billing. Only 28 % of such hospitals used data processing for patients' medical records; and 14 % used it for medical research [ 61 ].During the 1960s and 1970s, most American HISs focused on automation of hospital administrative services. Ball [ 6 ] categorized the earliest (1960s) operational HISs as the First Generation Level-1 HIS. These encompassed a basic set of inpatient-oriented computer applications, including: an ADT (admission-dischargetransfer) application with bed status and census reporting; an order/requisition entry, communication, and charge collection application; and an inquiry application for today's charges for demand bill purposes. Ball characterized changes in the 1970s as Second Generation Level-1 systems, with enhancements that included: computer-assigned patient identifi cation; nursing order-set entry, nursing notes and care plans, medication schedules and medication monitoring; laboratory-specimen collection lists and labels; order entry and results reporting; scheduling for patients, radiology procedures, and the operating room; medical records indexing, abstracts, and chart locations; diet-list preparation; utilization review; and doctors' registries. An advanced ...