Information Systems in Health Care
Information Systems in Health Care
Dr Abdollah Salleh,
MBBS (Malaya), Diploma of Fellowship RCS Edinburgh, RCPS Glasgow,
Health Information Management Consultant,
Life Member Malaysian Society for Quality in Health, Malaysia,
Honorary Academician, Medical Faculty, UITM, Malaysia,
Former Consultant General Surgeon, Ministry of Health Malaysia,
Former Clinical-IT Coordinator Hospital Selayang, Malaysia.
e-mail: [email protected]
website: drdollah.wordpress.com
The information management system complements the other components of the very complex
organizational structure and operations of a hospital. Its scope, content and structure serve a
myriad of functions. It contains a set of sub-systems and applications that utilizes information
technology and computerization optimally to facilitate the delivery of services of the hospital.
In general, the various functions and services that can be facilitated by information systems can
be divided into two main group of activities:
The set of fully integrated hospital-wide information systems that support the activities is called
the Hospital Information System (HIS). It is focused primarily on the Operations Management of
the hospital. However, data available from the system may be collated, analyzed and used for
strategic or project management and research. The HIS is envisaged as consisting of two broad
systems i.e.
The Hospital Information System should be capable of sharing patient data with other health care
institutions so as to enable continuity of care via the Telemedicine approach or other means. It is
expected to contribute to the national health database (in Malaysia: the National Health-
Management Information System) by supplying information for health promotion, disease
prevention and early detection efforts as well as for planning, resource allocation, epidemiology,
case-mix calculations etc. at district, state and national level. It should also provide information to
systems belonging to third party institutions e.g. external agencies like the Drug Safety Council,
Registration Department, Road Safety Council, the Police, Insurance companies and many others.
The information systems and applications are usually considered to consist of modules for ease of
description. Each module may have its own subsystem or the various modules may be shared in a
virtual server. It is expected that the Hospital Information System is fully integrated so as to
function seamlessly across modules. Integration refers to the interaction between applications
software with each other and with the hardware that supports it, enabling one to work with
another for a desired purpose. Poor integration often make it necessary for the user to go
through extra steps to complete a task and also slows down the system response time. A
substantial part of integration is the interfacing of information system computers with computers
of hardware (machines, measuring apparatus and etc.) enabling them to engage in transfer and
retrieval of data or instructions. Integration can be achieved at the stage of:
A. HIS design
B. Implementation
It would be desirable to design or procure a HIS that have been fully integrated from the start and
where the modules and sub-systems are proven to interact smoothly with acceptable response
time and ease of use. Trying to integrate disparate applications software with different data
structure and using different operation systems at the time of implementation would be an
unenviable task. Integration usually involves two or more parties. Sharing out of responsibilities,
agreeing on a schedule and assigning costs are issues that can pose a stumbling block to speedy
and successful implementation.
Another important consideration is the coordination between services and units within the
hospital so that the each module takes into consideration differences in their policies and
procedures. It would be desirable for these policies and procedures to be made complementary,
uniform and standardized. Minor variations can be allowed.
The clinical and other functions relating to the care of a patient is facilitated by a set of systems
which can be given a generic name of Information Systems for the patient care function. The
term Patient Care Information System is attractive and acceptable but, unfortunately, is used
only by small number of advocates. This term will be used in all subsequent discussions here
because this extra category level clarifies the nomenclature of systems. The entire system is made
up of sub-systems each of which can be discrete and seldom integrated when built. The term
Clinical Information System (CIS) should not be used to mean the whole Information Systems for
patient care. The name CIS should be confined to the system that facilitates or supports direct
patient care functions. Another commonly used term is 'EMR/EHR Systems'. This should not be
used at all because information systems are useful only if they facilitate work rather than "the
creation, storage, and organization of electronic medical records" as understood by some.
Any system being designed, proposed or implemented must possess characteristics that would
fulfil all the above objectives and functions; both in its content and the methods used.
For the sake of choosing the best of the breed it may be necessary to procure separate systems
or from different vendors e.g. for Systems for Clinical Support functions, the Charging-Billing-
Receipt of Payment Application and various clinical support systems. It is imperative that these
are demonstrated to be capable of full integration with the rest of HIS.
All the above systems are used by health care personnel to care for patients. Care is here defined
as all work activities to deliver services to patients in response to their needs.
It is crucial that the Information System for the Patient Care Function is able to integrate with
other systems of HIS. It must support the activities of incident reporting, clinical epidemiology,
disease surveillance, quality management, utilization review, risk management and similar
functions. Due consideration must be given to areas where Management Information Systems
interact with the Information System for the Patient Care Function. Examples of such areas are
Charging and Billing, Human Resource deployment, Bed allocation and Food-Beverage services.
Integration within the Patient Care Information System is essential. The main patient care
applications software i.e. the Clinical Information System and the various Clinical Support Systems
are built around key bridging (intermediary) applications i.e.
These applications are thought of and designed first and then amended as each clinical and
clinical-support application is designed. Any additional applications software is designed to be
compatible with these key bridging (intermediary) applications.
Chart Showing Bridging Role of Four Key Applications of the Patient Care Information System
The Patient Administration/Management System (PMS) supplies data to the Patient Information
Database from which the Electronic Medical Record (EMR) is derived, thus obviating the necessity
for identification and demographic data to be obtained repeatedly.
The Order Entry (CPOE) application acts as a means of communications between care providers
and the tool for planning, initiation, execution of processes and enabling charging-billing.
The Patient Information Database enables data generated by each user to be shared with others
through displays on the computer screen, printed material (documents & labels) or exported to
other communication systems.
The traditional function of the paper-based Medical Record is to make available historical data to
future clinical users for continuity of care and to non-clinical users for various valid purposes. In a
computerized environment, most of the functions of the paper record (i.e. the capture, storage,
distribution and communication of data) is taken over by the Patient Information Database. The
content and arrangement of data in the clinical applications and database need to take into
account of the legal and professional requirements of the Medical Record. A data extraction
application is then designed to generate the Electronic Medical Record.
The Managerial Information System refer to the set of sub-systems and applications that assist
managers in running the hospital as a:
business entity
provider of hospitality services
physical facility
The term 'managerial' is generic and refers to a set of sub-systems useful for managers. It is used
here because other terms such as Management / Operations / Business / Enterprise Resource
Planning systems have their own usage.
The components making up the Managerial Information System is wide-ranging and complex.
They are not within the scope of this discussion (at this point) but mentioned here for
completion. However certain components that integrate or interface with the Information
System for Patient Care Function will be discussed.