Information Technology in Healthcare

1. Information Technology in Healthcare Dr Keith Boardman Director of Computer & Network Services University Hospitals Coventry & Warwickshire NHS Trust

2. The NHS as a Business

3. National Health Service • Formed in 1948 • Employs 1 million people • 500 health authorities • Costs £37 billion • Treats 8.4 million in-patients a year • About 3 million day-cases a year • 40 million out-patient attendances • 30,000 GPs

4. UHCW NHS Trust • Acute Trust with 1246 beds • 11 Regional Specialities • Meets 98% of Coventry & Rugby acute healthcare needs • Contract Income £200M approx. • 6000 employees

5. Urology General Surgery Ear Nose & Throat Ophthalmology Oral Surgery Orthopaedics Rheumatology Dermatology General Medicine GP Maternity Gynaecology Special Care Baby Unit Paediatrics Obstetrics Cardiac Surgery Thoracic Surgery Cardiology Renal Transplantation Renal Dialysis Neurology Neurosurgery Radiotherapy Bone Marrow Transplantation Haemophilia Services Neonatal Intensive Care General Specilaties Regional Specialties

6. In-patient attendances - 90,000 Out-patient attendances - 306,000 Emergency assessments - 27,000 Accident Dept attendances - 103,000 Pathology requests - 865,000 Radiology Examinations - 207,000 MRI & CT Scanning - 13,000 Patient meals - 1,400,000 Staff meals - 744,000 Activity Levels

7. Computers in Healthcare Key application areas: • Information Management • Treatment • Diagnosis

8. Information Management • Hospital Administration Systems • Community & GP Systems • Clinical Information Systems • Business Systems

9. Hospital Information Systems A HIS meets the real-time operational information needs of health professionals to deliver care to patients, whilst also providing accurate and timely information for management purposes.

10. HIS Benefits • Improved care and delivery of services provided to patients • Reduced administrative work • Better information for resource management

11. HIS Functional areas (used by 1500 staff) • Patient Administration • Admissions, Discharges and Transfers • Accident & Emergency • Maternity • Operating Theatres • Professions Allied to Medicine • Case Note Tracking • Contracting& Billing

12. HIS Computer System: • HP9000/K460 running UNIX • 2 G Byte RAM • 100 G Byte disk storage (RAID) • 128 V24 ports • IEEE 10/100 MHz Ethernet • Cartridge Magnetic Tape • DLT Magnetic Tape

13. Clinical Information Systems Intranet & Internet Clinical Information System Radiology Pathology Clinical Documentation

14. Computer Systems Overview HIS HP9000 Community HP 9000 Breast Scr’ HP 9000 MIS General E-Mail Local Area Network (with ATM backbone) PC Client Access Radiology Sun Renal HP 9000 Pathology RS6000 Pharmacy RS6000

15. DATA INTEGRATION Pathology System Radiology HIS Interface Engine Clinical System (Data Warehouse) PC Client Access Local Area Network (with ATM backbone)

16. Wide Area NHS Communications Internet Secure Gateway NHSnet Intranet

17. Information for Health An Information Strategy for the Modern NHS 1998-2005

18. Top level commitment “The challenge for the NHS is to harness the information revolution and use it to benefit patients”. Rt. Hon. Tony Blair All Our Tomorrows Conference 2 July 1998

19. Purpose of the strategy . . . . to put in place over the next seven years the people, the resources, the culture and the processes necessary to ensure NHS clinicians and managers have the information needed to support the core purpose of the NHS. And to ensure the public and patients have a range of quality information easily accessible about health and health services.

20. Treatment and care Primary care EHR NHS Trust EPR Social care records Knowledge for Analysis Public Patients Healthcare professionals Managers Public health Clinical Governance Health Improvement Programme Performance management

21. Defining electronic records • Electronic Patient Record - a record of periodic care provided by one institution, typically an acute hospital • Electronic Health Record - the concept of a longitudinal record of a patient’s health and healthcare to combine information from primary healthcare with periodic care from other institutions

22. Better Practice Systems + Electronic Health Record ( EHR ) INFRASTRUCTURE (wires,security,standards) Better Hospital Systems + Electronic Patient Record ( EPR ) National Electronic Library of Health ( NELH ) 4 Key Pieces of the Strategy

29. Computers in Healthcare Key application areas: • Information Management • Treatment • Diagnosis

30. Computers used in Treatment • Radiotherapy • Intensive Care • Patient Communication Aids • Protheses

31. Computers in Healthcare Key application areas: • Information Management • Treatment • Diagnosis

32. Computers used in Diagnosis • Computerised Tomography • Magnetic Resonance Imaging • Ultrasonics • Radioisotope Imaging

33. Medical Imaging

35. Computerised Tomography

41. Intracranial haematoma

42. Renal tumour

43. Magnetic Resonance Imaging Protons in a magnetic field have a microscopic magnetization and act like tiny toy tops that wobble as they spin. The rate of the wobbling or precession is the resonant or Larmor frequency. In the magnetic field of an MRI scanner there is approximately the same number of proton nuclei aligned with the main magnetic field as counter-aligned. On a macroscopic level, exposure of an object or person to RF radiation at the Larmor frequency, causes the net magnetization to spiral away from the static field. Relaxation is the process whereby nuclear magnetization returns to its resting state following a perturbation, such as by an RF pulse.

44. An MRI Scanner

45. Magnetic Resonance Imaging

48. Lumbar Spine

49. Knee Anatomy

50. Baker’s Cyst