Contents

• Definition And Purpose Of Hospital Information Systems
• Advantages of Hospital Information Systems
• Development And Future Of Hospital Information Systems
• Types Of Hospital Information System
• How Hospital Information Systems Are Organized
• Nursing Informatics: What It Is And How It Impacts Hospital Caregivers
• Patient Documentation Systems
• Getting Computer Access Where It Needs To Be In Hospitals
• Working with Hospital Information Systems

About this document...

To return to the Table of Contents, click on the rainbow bar wherever you see it.

A Hospital Information System (HIS) is a computerized system designed to meet the information needs of all (or most) of a hospital. This includes many diverse types of data, such as:

• Patient information
• Clinical laboratory, radiology, and patient monitoring
• Patient census and billing
• Staffing and scheduling
• Outcomes assessment and quality control
• Pharmacy ordering, prescription handling, and pharmacopoeia information
• Decision support
• Finance and accounting
• Supplies, inventory, maintenance, and orders management

• Increased time nurses spend with patients
• Access to information
• Improved quality of documentation
• Improved quality of patient care
• Increased nursing productivity
• Improved communications
• Reduced errors of omission
• Reduced medication errors
• Reduced hospital costs
• Increased nurse job satisfaction
• Compliance with regulations of the Joint Commission on Accreditation of Health Care Organizations (JCAHO)
• Development of a common clinical database
• Improved patient's perception of care
• Enhanced ability to track patient's record
• Enhanced ability to recruit and retain staff
• Improved hospital image

• It costs approximately $5,000 to computerize a nursing administrative office
• Administrative uses of Hospital Information Systems can save approximately $36 billion each year in the U.S.

(Estimates from Saba & McCormick 1996, p.308)

Others were developed during the 1960s primarily for storing patient information to be used by medical staff.

These types of systems have been slow to integrate. Surveys (Dorenfest 1987, 1992) of hospitals since 1980 have shown that less than half of community hospitals have full Hospital Information Systems, mainly because few were available to integrate all the functions needed. Research and teaching hospitals presumably have a much higher usage of Hospital Information Systems.

The future is not certain. Several factors are at work:

• Computer hardware is getting more affordable
• Computer software is not getting any less expensive
• Budgets for Hospital Information Systems are generally not expanding
• Medical caregivers are under pressure to handle more patients on an outpatient basis, reducing hospital census and generally reducing hospital budgets
• Standards for storing and exchanging patient information have not been agreed on
• An overall plan for national health care - which could have a big impact on Hospital Information Systems - has been a political football, leading to uncertainty in planning.

• centralized or decentralized plans
• software that was originally business-oriented or patient-oriented
• terminals or workstations

Centralized vs. Decentralized

There are variations on this; for example, a system may be partially centralized but integrated with powerful and somewhat independent satellite systems. Examples:

• Some systems may centralized certain functions like billing and accounting in an administrative facility serving several affiliated hospitals, while other functions like patient record-keeping are carried out at the individual hospitals or medical units.
• Other systems may centralize their patient record-keeping and have smooth exchange of information with a specialized clinical laboratory computer system which is mainly independent of the primary HIS.

Business Oriented vs. Patient Oriented

Terminal vs. Workstation Oriented

Terminals are electronic devices that let humans communicate with a computer. They are generally connected to minicomputers or mainframes, which could be close by or halfway around the world. They may have some minor processing power of their own, but are generally not able to do anything if not attached to a (functioning) computer.

Workstations are computers designed for professional use by one person at a time. They are fully functional computers on their own, but they can be networked to other workstations, mainframes, or minicomputers. (The term workstation can refer to any personal computer, but is often applied to specially powerful microcomputers.)

Terminal-oriented systems are by nature very centralized, since the terminal can't do anything on their own. Workstation-oriented systems can be either centralized or decentralized, because the processing power of the workstation gives system designers a lot of flexibility.

The trend in most types of computer work is toward decentralization, but this trend is somewhat slower in hospitals because of the high risks associated with failure in hospitlas and the consequent reluctance to change systems that are working now.

Still, workstation-oriented systems offer a number of advantages over terminal-oriented ones:

• Greater flexibility: information can be either centralized or decentralized.
• Workstations are much more independent: they can function to some degree even when a central system is "down".
• Since they are used by only one person at once, workstations don't slow down when lots of people are using the system (except when they are requesting information from a central database).
• Workstations let people do many kinds of work, including word processing and general calculation, which are not practical on terminal-based systems.

Symbols used in these diagrams:

(Figure 0)

• Fully centralized system:
 
(Figure 1)


• Centralized with access to a parallel system in clinical lab and radiology:

(Figure 2)


• Workstation oriented with centralized patient records:

(Figure 3)


• Fully distributed with workstations:

(Figure 4)

How do these different systems affect you?

• All give you complete access to all relevant data
• Parallel system in lab/radiology gets results faster
• Workstations provide more features than terminals
• Distributed systems are often more reliable than centralized ones

What is Nursing Informatics; Who is Involved?

Nurses may specialize in informatics, taking jobs with titles such as:

• nursing informatics (or information) specialist
• nursing systems analyst
• computer nurse
• systems nurse

The need for Nursing Informatics

Nurses identified as informatics specialists numbered 15 in 1981; there were over 5,000 by 1991 (Saba & McCormick 1996). Many hospitals, recognizing the need for this type of person, select nurses with computer facility to study and become the resident specialist.

Impact of Nursing Informatics

• Channel information from caregivers to computer systems designers
• Help select computer equipment suitable to nursing needs
• Educate computer staff about medical matters
• Educate medical caregivers about computer systems

• The American Nurses Association (ANA) is working to develop nursing data standards through its ANA Database Steering Committee.
• Several nursing organizations are working to define a standard "Computer Patient Record" (unfortunately known as a CPR...)
• Specialists are developing ways of classifying and computerizing aspects of nursing such as:
• Nursing intervention lexicon and taxonomy
• Effectiveness of patient care
• Internationally accepted vocabulary for describing medical and nursing matters
• Classification of nursing practice
• Several specialists are studying ideal ways for information to flow from one point to another in the hospital environment
• Other specialists are studying the best ways to computerize nursing management and education.

Where is Nursing Informatics Used?

• Nursing administration
• Nursing practice
• Critical care
• Outcomes and guidelines
• Community health nursing
• Nursing education
• Nursing research

• Basic patient information (name, address ...)
• Diagnostic information
• Physicians' orders
• Medication data
• Vital signs, intake/output, and physiological measurements
• Diet information
• Event reports
• Nursing notes
• Billable procedures; supplies consumed
• Care plans
• Discharge plans
• Case management information

1. By the patient's bed
2. In the hall close to the patient's bed
3. In a staff-only area such as the nursing station or ward office

By the patient's bed

Bedside placement is necessary for monitoring systems and intervention control devices like infusion pumps. For documentation of patient condition, however, there is no advantage to this. A study (Marr et al. 1993) found that reporting did not improve when nurses had bedside access to the HIS, since most of their note were entered either outside patients' rooms, or in the rooms of other patients. However, putting HIS access by the bedside did improve the use of computerized patient care plans, calculation of patient acuity, and billing for nursing services.

In the hall

Hallway placement of HIS access appears to be gaining popularity. It allows nurses to do their documentation very soon after leaving the patient's bedside, without the distraction of having the patient present, possibly demanding attention. There is a security risk in the hall, as unauthorized individuals may gain information about a patient's condition by peering over the nurse's shoulder.

Staff-only area

Placing access in areas where only staff are permitted has the advantage of greater security. But the price is loss of convenience and timeliness, as the staff need to take a hike from the patient's room every time they need to enter information.

Other possibilities

"Electronic clipboards" (similar to the devices used by delivery companies such as United Parcel Service and Federal Express) have great promise in making it easier to enter reports in a timely manner. One possible disadvantage: "Whose room did I leave that confounded clipboard in this time?!?"

1. Order entry
2. Integrate care plans with charting functions
3. Prepared patient care plans
4. Track medication administration
5. Discharge planning
6. Determine patient acuity level (severity of patient's condition)
7. Provide flexibility to customize the system for your hospital
8. Report generator capability
9. Prepare nursing assessments
10. Patient education
11. Quality assurance
12. Access to information in many departments of the hospital
13. Admission interview
14. Patient acuity list
15. Cost tracking and reporting
16. Electronic mail to other departments
17. Graphical display of patient data
18. Automated medical record
19. Bedside capability (but only 29% said they had this)
20. Case management of critical pathways

Dorenfest, S. 1993.

The Dorenfest 3000+ Database and the Dorenfest Guide to the Hospital Information Systems Market. Chicago: published by the author. Quoted in Saba and McCormick 1996, p. 190.

Marr, P., E. Duthie, K. Glassman et al. 1993.

Bedside terminals and quality of nursing documentation. Computers in Nursing, 11(4), 176-182. Quoted in Saba and McCormick 1996, p.371.

Saba, V. and K. McCormick. 1996.

Essentials of Computers for Nurses. Second edition. New York: McGraw-Hill.

Simpson, R. 1992.

What nursing leaders are saying about technology. Nursing Management, 23(7), 28-32. Quoted in Saba & McCormick, pp. 358-9.

Audience:

Objectives

• Discuss types of Hospital Information Systems
• List the major advantages of Hospital Information Systems
• Recognize the types of information stored in most Hospital Information Systems
• Explain the general organization of Hospital Information Systems
• Explain how a Hospital Information System is used by health care staff
• Discuss the advantages of a Hospital Information System.
• Recognize the main types of information handled by Hospital Information Systems
• Recognize the types of information that usually makes up patient records
• Discuss the nature and impact of nursing informatics

About this document...

Module M30c: Introduction to Hospital Information Systems

Author:

Laurence J. Krieg

Institution:

Department of Computer Information Systems, Washtenaw Community College

Date:

Original 9 April 1996; review added 26 March 1999