Challenges and Forces Driving Adoption of Health Information Technology and Electronic Healthcare Records

In this segment on Electronic Healthcare records, being sponsored by Physicians Office Resource, we will look at: 

What are all these different terms’ being used in Health Information Technology?

Sometimes it is important to stop and make sure that we are all on the same page and understand what we are all taking about. With this in mind we will address terminology and help you understand the “basic” concepts of technology used in today’s healthcare environment.

• Types of healthcare information technology (HIT) systems
• Basics of an operating system
• Communication technologies (includes networking and wireless technology)
• The need for data exchange formats between systems that communicate
• Healthcare information storage technologies
• Healthcare information technology implementation solutions

As patient information is being converted to electronic (digital) technology, a number of healthcare information technology (HIT) systems have evolved to provide solutions for various functions of the patient information workflow paradigm. Some key functions of patient workflow include;

• Patient registration – identifying the patient
• Patient census management – where is the patient (admissions, transfers, discharges, visits)
• Scheduling procedures – ordering exams (tests) for a patient
• Collecting patient information – charting, clinical notes, history, vital signs, procedures,…
• Storing the patient information
• Clinical decision support
• Generating clinical reports – to be used for patient assessment and treatment
• Charging the patient (or insurer) for performed procedures

It is common for a healthcare provider organization to have multiple, coordinated HIT systems that solve their overall patient information workflow. In this section, we will identify HIT systems that support one, many or all functions of the patient information workflow.

Types of Technology:

PACS - Picture Archiving and Communications System

• Roles; scheduling procedures, information (image) collection and reporting
• PACS systems are coordinated with HIS and EMR systems (see below) and provide the management of clinical information that requires image management. Image based applications include radiology, cardiology imaging (Echo, Nuclear,…), dentistry, orthopedics,…)

ECGDMS - ECG Data Management System

• Healthcare environment; hospitals and large cardiology practices
• Roles; manage ECG workflow; scheduling, collection, storage, reporting and billing
• ECGDMS systems are coordinated with systems such as HIS or EMR (see below) to support patient census, procedure scheduling, reporting and billing workflow
• HIS - Hospital Information System

HIS - Hospital Information System

• Sometimes referred to as a CIS (Computer Information System)
• Healthcare environment; hospitals
• Roles; patient registration, patient census, procedure scheduling and billing
• Often coordinated with PACS, EMR and ECGDMS systems

EPM – Practice Management System

• Healthcare environment; physician office and group practice
• Roles; patient registration, procedure scheduling and billing
• Often coordinated with EMR systems (see below)

EMR - Electronic Medical Record System

• Sometimes referred to as an EHR (Electronic Health Record system)
• Healthcare environment; physician office, cardiology and specialty practices
• Roles; varies widely. All support collection, storage and reporting of clinical information. More mature systems will support practice management capabilities. The patient clinical information managed in an EMR can vary. Some systems are focused on a specific specialty, e.g cardiology, GI, family practice, dental,… to  systems that encompass all types of clinical information

RIS - Radiology Information System

• Healthcare environment; hospital, radiology imaging centers
• Roles; manage patient registration, scheduling, collection, storage, reporting and billing. In the hospital environment, it is often coordinated with the HIS or EMR system. The RIS system utilizes a PACS system for storage o f the images

Basics of an operating System

As patient information is being converted to electronic (digital) technology, the computer plays the key role in coordinating this information. The operating system is the “middleware” (software) that coordinates the flow of information between “applications” processing that information and the computer “hardware”. Some key hardware functions of a computer are;

• central processing unit (CPU)
• processing memory (RAM – random access memory)
• input devices (keyboard, mouse, scanners)
• output devices (display monitor, printers, fax, speakers)
• networking
• data storage (hard drives)

In this section we will explore the basic operation of an operating system and hilite some common operating systems used by healthcare facilities.

What is digital information?

The smallest amount of information that can be represented in digital format is called a ‘bit’. A bit can only hold one of two values;  ‘0’ or ‘1’. Information contained in a single bit is not useful for representing information that is useful. However, when we group a number of bits together we are able to represent more meaningful data (information). A grouping of 8 bits together is called a ‘byte’. A byte is the smallest unit of measure that represent something that is human readable. For example, a byte of information can represent letters of the alphabet; A, B, C,…or numbers; 1,2,3. If we can group multiple bytes together, we can start representing even more useful information; such as names; John (4 bytes) and sentences; ‘The fox jumped over the fence’ (30 bytes).

How do computers utilize digital information?

The various hardware components of a computer communicate with each other by exchanging data using the digital information format. For example, a user types in a sentence ‘I’m watching football’ on the keyboard (input device). The keyboard sends this information to the central processing unit (CPU) with an instruction to display it on the monitor. The CPU stores the sentence in the processing memory (RAM). The information is then displayed on the computer monitor (output device) from the memory. The operating system running on the computer coordinates all of this activity.

So what does a 32 or 64 bit computer mean?

The first personal computers were based on an 8 bit technology. This means that the digital information is exchanged between the various computer hardware components used an 8 bit format. As computer hardware technology became more sophisticated, we have seen 16, 32 and now 64 bit formats supported. With each instruction executed by the computer, it is now able to process more information. For example, for a single computer instruction; a 64 bit computer is able to process 8 times more information as an 8 bit computer. This means that the computer operates faster and more efficiently.

In order for computers to work correctly, the operating system (software) must be “bit” compatible with the computer hardware it is running on. For example, a 64 bit computer requires a 64 bit operating system. However, many operating system vendors (e.g. Microsoft) can provide a 32 bit operating system that can run on a 64 bit computer hardware; just not as efficiently.

What is important to know about an operating system?

Computer applications (word processors, spreadsheets, email,…) are built by software development tools that are designed to work in a specific digital (bit) format. These applications communicate with the operating system in the bit format (32 or 64) that is specified by the software development tool. Applications built for a particular bit format operating system may not work on another bit format operating system. This is called software incompatibility.

What else is important to know about an operating system - continued

Operating systems also play another important role. The operating system acts as a mediator between the applications running on the computer and the actual computer hardware. In the early days of computers before operating systems were common, the applications needed to be built to communicate directly to the hardware. Even though this worked, it was not very portable. Taking the application to another computer system, or changing the hardware in a computer would cause the application to fail. Modern operating systems now isolate the hardware from the application; primarily through the use of a sofware modules called device drivers. For example, your laptop is able to communicate with a wide variety of printers. All that is necessary to make the printer work is to install the correct “print driver” that matches your computer.

What is meant by “client” and “server” based operating systems?

Microsoft has developed operating systems that are targeted for specific technology environments. “Server” based operating systems are targeted for environments that require high reliability and availability (uptime) such as; web servers (web sites), database servers (data repositories) and print/fax servers. “Client” operating systems are typically found on workstations, laptops and netbooks. They commonly access information from systems using server based operating systems (web sites and data repositories). In addition, these client operating systems often work in an environment where the host computer is turned off.

Server based operating systems

• Windows 2003 Server (32 bit)
• Windows 2008 Server (32 and 64 bit)
• Linux
• Unix

Client based operating systems

• Windows XP Professional
• Windows VISTA

Next Issue:

In our next issue we will discuss.

• Communication technologies
• Includes networking and wireless technology
• The need for data exchange formats between systems that communicate
• Healthcare information storage technologies
• Healthcare information technology implementation solutions