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Web-Based Medical Records Design and Implementation at Columbia-Presbyterian Medical Center

This study explores the design and implementation of web-based medical records at Columbia-Presbyterian Medical Center, from the pre-TCP/IP era to the use of modern internet technologies. It discusses the evolution of the system, its features, advantages, challenges, and integration with online resources.

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Web-Based Medical Records Design and Implementation at Columbia-Presbyterian Medical Center

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  1. Web-Based Medical RecordsDesign and Implementation atColumbia-Presbyterian Medical Center James J. Cimino, M.D. Department of Medical Informatics Columbia University

  2. CPMC in 1988 - preTCP/IP IBM Mainframe Data Repository Data Monitor Vocabulary Server Results Review Ancillary Systems Clinicians

  3. Data Monitor - Input and Alerts • Stores all data in repository • Checks data for triggers • Executes Medical Logic Modules • Stores alerts in repository

  4. Data Repository • Row-oriented relational database (DB2) • Event-oriented • Flexible and extensible • Clinical data coded with MED • Multiple time stamps

  5. CPMC in 1991 - TCP/IP IBM Mainframe Data Repository Data Monitor Vocabulary Server Results Review Intranet Minicomputer Minicomputer Upload Engine Clinical Application Vocabulary Server Vocabulary Server Ancillary Systems Clinicians

  6. Clinical Database Server - Output • Dynamic queries (SQL) • Canned queries • Time span • Last "n" results • Class-based retrievals ("get all positive culture results")

  7. Medical Entities Dictionary (MED) • 56,000 medical concepts • 82,000 synonyms • Multiple hierarchy (72,000 links) • Semantic network (43,000 links)

  8. MED Semantic Network Medications Chemicals Tests Findings Calcium Preparations Intravascular Calcium Tests Abnormalities of Calcium Calcium Serum Calcium Plasma Calcium Hypercalcemia Hypocalcemia

  9. MED Server • Lexical searching • Concept attributes • Classes • Ancestors

  10. CPMC in 1994 - WWW IBM Mainframe Data Repository Data Monitor Intranet Minicomputer Internet Web Server Internet Vocabulary Server Knowledge Resources Clinicians

  11. Web Server • Clinical database server queries • Vocabulary server queries • Class queries • Translation • HTML document generation • Applets • Web links

  12. Web-Based EMR IBM Mainframe Data Repository Data Monitor Intranet Minicomputer Web Server Vocabulary Server Clinicians

  13. CPMC’s Web EMRs • Elpis - single patient view • PolyMed - service view • WebCIS - multiple views • PatCIS - for patients

  14. Web EMR Features • Frame-based interface • Summary reporting • Graphical displays • Multimedia displays • Cross-patient displays • Order entry • Integration of on-line resources • Security and confidentiality

  15. Screen Shots of WebCIS

  16. PatCIS • Data review • Data entry • Education • Advice • Infobuttons

  17. PatCIS Architectural Features • Frame-based user interface • Buttons and "sub-buttons" • Single central CGI • security • usage logs • JavaScript functions to support application integration

  18. PatCIS Architecture Web Server Web Browser 2 patcis.cgi 3 4 Data Entry Session Registry Java Script Vital Signs Blood Sugar Logout 5 Data Entry Re-enter Password 1 6 Review Advice Education CGI Usage Log Link Comments Help 7 8 9 10 11 JavaScript CGI Internet

  19. Advantages of PatCIS Design • "Light" user interface • Handles security for applications • identification • authentication • authorization • logout • timeout • Handles logging functions • tracks usage • records accesses to clinical database • Maintains consistent look & feel

  20. Screen Shots of PatCIS

  21. Integration with On-Line Resources Intranet Minicomputer Internet Web Server Internet Vocabulary Server Knowledge Resources Clinicians

  22. Integration through Terminology 4 5 2 Automated Translation Get Information From EMR Resource Terminology 6 1 Querying Understand Information Needs 3 7 Resource Selection Presentation

  23. Infobuttons DXplain Cholesterol Guideline Laboratory Test Results PDR Dietary Interactions Micromedex Medication Orders Medline Clinical Info System X-ray Reports Radiol Museum of South Bank Webpath CHORUS

  24. Screen Shots of Infobuttons

  25. Security and Confidentiality • User logon name and password • Encryption (SSL) • Logon screen ID (single use) • Session screen ID (expires) • Database access log

  26. Current Challenges • Security • User ID management • No control over client machines • Application development • Navigation of hypertext • Resource integration • Evaluation

  27. Ingredients for Success • Powerful, flexible back end • Repository • MED • HTML and HTTP • Web resources • People

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