Hopes And Constraints Concerning Hospital Information System

1. Hopes And Constraints Concerning Hospital Information System Dzintars Mozgis, Dr.med Chairman, Board, University Hospital for Children, Riga, Latvia Vladimirs Strazdins, MD Head, Nephrology, University Hospital for Children, Riga, Latvia Baltic IT&T 2005 Forum

2. Initial Expectations • Our cultural and historical tradition is neither the best, nor the worst, but it surely determines the reality • We expected (and quick) to create the electronic patient management system able to copewith: • Patient registration & scheduling • Electronic medical records • Lab management • Pharmacy management • Medical billing • Long-term care • Medical practice management, etc. Baltic IT&T 2005 Forum

3. Harsh Reality • We were wrong! • Though with big efforts and a long time, but fortunately not investing the big money we have completed only the first step (registration) by now • By constantly putting in the extensivepersonal efforts, time and enthusiasm we currently may probably be in the middle of completion of the next three to four steps • Patient scheduling – on the way • Lab management – on the way • Pharmacy management - on the way • Electronic medical records - slowly developing Baltic IT&T 2005 Forum

4. Main IS Principles • From the IT point of view the clinical (medical) workstation is an interface between the computer network and medical, patient care, and administrative processes • While developing the concept of our hospital IS we decided it should provide our staff with the maximally simple (operated on the intuitive level) easily accessible data base with only basic data processing • The user should not even be aware of the database structure, operating system involved, or other technicalities Baltic IT&T 2005 Forum

5. Decision-making Policy • Evidence-based and cost-effective treatment requires the correct account of the expense involved, and the quality management needs the comprehensive integration of the related information • Only then the particular therapeutic or diagnostic issue analysis will become possible, and as a result the proven concepts of therapy, guidelines, and protocols will develop • It is essential not to base those end products on the single person’s (doctor’s) opinion like traditionally done in previous years, but to make those solidly based on proven results and teamwork analysis of the quality and other parameters achieved Baltic IT&T 2005 Forum

6. Do Not Expect Wonders • It is wrong to expect the hospital IS to raise the productivity by itself • Though both hardware and software costs are dropping, the hospital IS at least initially looks more like a bottomless cavity, where you can dump the investments with actually no limits • The initial phase usually results even in productivity decline due to learning processes, especially for those with low or absent PC user skills, who are usually afraid of using the IT Baltic IT&T 2005 Forum

7. Limitations • There are enormous data quantities in medicine • The usual attempt is to collect and to store all available data in all details, and for as long as possible • The above concept is completely wrong, since no technical resources are available to store the data and make those available in a few seconds time • Attempts to develop such a system end up with a mighty expensive data graveyard! • Take your PC and look at what percentage of stored data you really use? Baltic IT&T 2005 Forum

8. Priorities • Therefore the most difficult and effort-consuming, but the mostly needed task is to define the priorities • Exactly what information and to what extent will certainly be (but not might be) needed in a future • The above determined our decision to avoid the most usual mistake to get everything available at once • We started to develop our hospital IS step by step, simultaneously learning and training ourselves • Only when one of the system components is ready, implemented, tested in daily routine and is well-accepted by end-users, we make the next step to start another module Baltic IT&T 2005 Forum

9. Hospital IS Requirements • Therefore, we concluded that the main requirements for hospital IS are • Low cost • High stability • High data security level • Minimal possibility of virus threat Baltic IT&T 2005 Forum

10. Our Choice • Hospital description • 600 pediatric beds in 23 specialized clinical departments (wards), supportive medical & non-medical units • Workstations • 40 Linux-based hospital IS workstations • 110 Windows-based hospital general network workstations • Servers: 4 firewall-protected (Hospital IS server, General file server, WWW server, and Mail server) • Connections: 100 mbps optical cable + 10 mbps UTP + 2 mbps Internet radio link Baltic IT&T 2005 Forum

11. Currently Implementing • Direct data input from automated lab analyzers • All lab equipment already changed to automated stations with data output modules • Pharmacy database connection to hospital IS • Current database is separate and uses a different data format • Outpatient clinic IS is under development from scratch • Scheduling, registration, lab data input, medical records, etc. Baltic IT&T 2005 Forum

12. Outside Connections • The ability to link clinical data systems between institutions is becoming more important as our society continues to develop • Local area and distributed networks are the probable means of providing such a linkage • Standardization of data format is crucial to facilitate the functionality of networks • Considering the possible data exchange with the primary care physicians we are cautious, since the most sophisticated and expensive IS will fail until the relations between those two levels will improve • It will take a long and intensive managing and psychological work to achieve the passable relations Baltic IT&T 2005 Forum