HEALTH / NURSING
INFORMATICS & TECHNOLOGY
UNITS
1. INTRODUCTION TO COMPUTER APPLICATIONS FOR PATIENT CARE DELIVERY
SYSTEM AND NURSING PRACTICE
2. PRINCIPLES OF HEALTH INFORMATICS
3. INFORMATION SYSTEM IN HEALTHCARE
4. SHARED CARE AND ELECTRONIC HEALTH RECORDS
5. PATIENT SAFETY AND CLINICAL RISK
6. CLINICAL KNOWLEDGE AND DECISION MAKING
7. E-HEALTH : PATIENTS AND THE INTERNET
8. USING INFORMATION IN HEALTHCARE MANAGEMENT
9. INFORMATION LAW AND GOVERNANCE IN CLINICAL PRACTICE
10. HEALTHCARE QUALITY AND EVIDENCE-BASED PRACTICE
UNIT INFORMATION SYSTEMS IN
3 HEALTHCARE
12. Role and Architecture of Information Systems
13. Clinical Information System / Hospital Information System
Role and Architecture of Information
Systems
Role and Architecture of Information Systems
► Definition of Healthcare Information System
► “HCISs as powerful ICT-based tools able to make health care delivery more
effective and efficient.”
– Rodrigues, 2010
► “HCISs as a synergy of 3 other disciplines – namely, Health Care
Management, Organization Management and Information Management.”
- Tan, 2005
► “HCISs comprises several different applications that support the needs of
healthcare organizations, clinicians, patients and policy makers in collecting
and managing all the data related both clinical and administrative process.”
- Rada, 2008
Structure/Architecture of Healthcare
Information System
► Layer 1 : Domain
Components :
▪ Data
▪ Functions of Hospital
► Layer 2 : Logical tool
► Layer 3 : Physical tool
Layer 1 : Domain
Layers 1 comprises Data that needs to be processed in the hospital, it will include,
► Data related to patient care (Example : Date related to case, patient, doctors
order diagnosis, etc.)
► Data related the provision of resources (Example : Appointments, rooms, beds,
medications, health care professional, etc.)
► Data related to the management process
► Data related to the administrative functions (Example : Archives of patient
records, classification of diagnosis, cost unit, etc.)
Layer 1 : Domain
Layers 1 also comprises the functions of hospital which tells us how and where in
the health care facility the data will be processed. The hospital functions include,
► Patient care
► Supply and disposal management, scheduling and resource allocation
► Hospital management
► Hospital administration
► Research and education
Patient care
► It is the function of the hospital that at the time of admission, irrespective of the
type of admission (short or long duration) a complete recording of patient data
should be done.
► This should include, demographic history, medical history as well as any insurance
data.
► In computer based HIS, there is a separate module for ‘patient registration’ to full
fill this requirement.
► Patients are correctly identified through their unique identification code, Unique
Patient Identification Code (UPID) generated by the system.
► This ensures better patient safety.
► Appointments (preventing the long queue of patients)
► Administrative admission
► Medical admission
► Nursing admission
► Visitor information service
Supply and disposal management, scheduling
and resource allocation
► Hospital has to ensure that there is adequate amount of supply for the
patient care that can easily be used by the health professionals.
► These supplies can be in the form of equipment, furniture, medicines, food,
safe drinking water, laundry, etc.
► To ensure smooth functioning of the hospital, delivery of these supplies
should be managed efficiently.
► The modern day HIS provides all such facilities under one roof.
► Scheduling and resource allocation includes the management of resources
in the clinical setting, like planning of beds, human resources, devices and
rooms.
► There should be proper coordination and planning required in the
management of these resources to get maximum results.
Hospital management
► Hospital management involves the overall managerial functions of the
hospital that focuses on the goal attainment.
► This domain makes strategies, personnel, budgets, investments, treatment
modalities, etc.
► The goal of management domain is to provide quality care to the patients
and also considering the financial and legal aspects.
► Helps in evaluating the overall performance of the health care facility in
terms of the goal achievement.
► Management focuses on overall business efficiency and financial strategy,
► Administration deals with overseeing day-to-day operations.
► Healthcare management focuses on the business side of healthcare. In
managing the healthcare operation, medical and health services managers
oversee the accounting, finances, and overall business practices for a
hospital or medical organization.
► Healthcare managers are responsible for treatment and patients standards,
implementing organizational policies, and managing the institution’s
budget. Almost all medical facilities have a healthcare manager, so the career
is in high demand.
Hospital administration
► Administration involves the “day-to-day” while management oversees the
“big picture”.
► Hospital administration focuses on individual departments and budgets,
day-to-day operations, and staffing.
► Hospital administration helps to coordinate different departments in order
to ensure an integrated patient care.
► Standardized formats are used in conducting the overall process that helps in
interoperability of records.
► Quality assurance is also considered as the part of managerial functions and
it is ensured through defining goals, implementing strategies and delegating
responsibilities to achieve those goals.
► Healthcare administration deals with the overall operations of a healthcare
facility. The main duty of a healthcare administrator is to ensure that
everything on the grounds of the hospital, clinic, or some other type of
healthcare facility is running smoothly.
► For this to be possible, you have to ensure that the right people for the
patients and the venue are hired. Generally, an administrator is having a
leadership role.
Research and education
► Research and education is important because evidence-based practice is
expanding in modern health care system.
► Research and education domain works for research management, carrying out
of clinical trials and experiments, knowledge retrieval and literature
management, dissemination and presentation and imparting programs to
educate the faculty.
► Evidence-based practice (EBP) is a way of providing health care that is based on
the best available scientific evidence, clinical expertise, and patient
preferences.
► The goal of EBP is to provide effective care and improve patient outcomes by
using the best evidence available.
Evidence-based practice (EBP) is a healthcare approach that combines three key elements:
1. Best available scientific evidence: This refers to high-quality research, including studies and clinical
trials, that provide strong evidence for the effectiveness of a particular treatment, medication, or
approach.
2. Clinical expertise: The knowledge, experience, and judgment of the healthcare professional play a
crucial role in EBP. They can consider a patient's unique medical history, condition, and any potential
risks or interactions with other medications.
3. Patient preferences: EBP doesn't disregard individual needs. Patients' values, preferences, and
overall well-being are factored into the decision-making process.
The goal of EBP is to move away from relying solely on tradition or personal anecdotes and instead base
healthcare decisions on the most up-to-date scientific evidence, while still considering the specific context
of each patient. This approach aims to improve the quality, safety, and effectiveness of healthcare
provided.
Layer 2 : Logical tool
► The logical tool comprises the applications related to the functioning of the health
information system.
It includes,
► Patient administration system
► Medical documentation system Other department specific computer
based components
► Nursing management and documentation system
► Pharmacy management system
► Outpatient management system
► Provider or physician order entry system ► Cardiovascular information system (CVIS)
► Patient data management system (PDMS) ► Decision support system
► Operation management system ► Pathology information system
► Radiology information system (RIS)
► Laboratory information systems (LIS)
Layer 3 : Physical tool
► The Physical layer comprises the physical data processing systems required to
install the application components.
► Servers and Communication networks
► Physical tool focuses on integration of physical data processing systems and
taxonomy of architecture at the physical tool layer
Clinical Information System / Hospital
Information System
HIS - Hospital Information System
► Hospital Information System is a term used to define hospital
computer systems with features like patient admission and
discharge, order entry for laboratory tests or medications, and
billing functions.
HIS - Hospital Information System
► Health information system (HIS) is a unified, computer assisted
system constructed to store, process, retrieve and analyze
information related to the administrative and clinical aspects of
providing services within the hospital setting.
► HIS refers to a system conceptualized to manage healthcare
data with a special focus on collecting, storing, managing and
transmitting a patient's Electronic Medical Records (EMR), a
hospitals operational management or a system supporting
healthcare policy decisions.
Database
► A database is a collection of data that is organized, which is also
called structured data. It can be accessed or stored in a computer
system. It can be managed through a Database Management System
(DBMS), a software used to manage data. Database refers to related
data in a structured form.
Types of Network Topologies
Client Server Architecture
► A server is a high speed computer that provides
information to other computers called "clients" on
computer network. This architecture is called the
client–server model.
► This is a network structure that combines resources
available commonly with that of the central server of
the hospital. These can be recovered as per the
requirement across the network by client computers on
the network.
► In client server architecture the server hosts, delivers,
and manages most of the resources and services
requested by the client
Objectives of Hospital Information System
► To enhance the quality of patient care through the process of integration of
data driven by the computer-based technology.
► To provide accurate, electronically stored medical records of the patients.
► To support the healthcare professionals in the clinic settings to manage
activities related to patient care.
► To regulate the administrative functions, like payrolls, personal
management, purchases and stores, etc.
► To evaluate the performance of the hospital.
► To asses the future requirements.
► To serve as the source of data for research.
► To aid in the process of decision making.
► To enhance interoperability of patient data.
Integrated Hospital Information System
► Hospital Information System (HIS) provides various services in an
integrated way and on the basis of these services, several domains
are being used by this specialized system of healthcare.
Front desk
Doctor
Inventory
Management
Finance
Hospital ward
Lab & radiology
Pharmacy
Needs of HIS
► Bring improvement in quality of patient ► Enhance modern finance and budgetary
care by providing accurate data. management.
► Deliver the information timely to the ► Improve the decision-making process due
right person at right time, at right place to integration of data.
and at an affordable cost.
► Decrease the need of human interaction
► Accelerate the exchange of information, in routine procedures.
thereby reducing the waiting time.
► Reduce the chances of errors.
► Ease the process of record keeping.
► Ensure patient safety in terms of data
► Minimize the time taken to document protection data privacy.
the findings because of the availability
of ready to use templates. ► Improve policy making.
► Spare time of the health professionals
for direct patient care activity.
Forms HIS
► The use of HIS is not only for the Hospital staff or health care
professional.
► The system can equally be used by others, like patients or the public
health officials.
► The HIS can be divided into 6 forms
1. Clinical Decision Support (CDS)
2. Electronic Medical Records (EMR) and Electronic Health Records (EHR)
3. Patient portals
4. Master Patient Index (MPI)
5. Practice Management Software
6. Remote Patient Monitoring (RPM)
Clinical Decision Support (CDS)
► Clinical decision support (CDS) systems evaluate data
from different clinical and administrative systems.
► CDS is beneficial to health care providers as it assists
in the process of taking clinical decisions.
► The data can be used to formulate diagnoses or to
predict the medical events, like drug interactions.
► The CDS helps the healthcare professionals to filter
the relevant data and information to enhance the
quality of patient care.
► Clinical decision support systems (CDSS) are computer-based
programs that analyze data within electronic medical records
(EMRs) to create alerts and reminders that help healthcare providers
implement more data-informed guidelines in their workflow.
Electronic Medical Records (EMR) and
Electronic Health Records (EHR)
► Electronic Medical Records (EMR) has replaced
the paper-based medical records to a greater
extent.
► Electronic Health Records (EHR) comprises data
related to health like the test results, and
treatment strategies as shown
► It also enables the users to share patient’s data
with other healthcare providers wherever
required to deliver patient care without wasting
the valuable time.
Electronic Health Records (EHR) and Clinical
Decision Support System (CDS)
► Electronic health records can be used simultaneously at different places at the
same time, which eases the process of clinical decision making.
► These records provide structured data that can be accessed easily at the time of
need without compromising the security issues.
Patient Portals
► Patient Portals allow the patients to access their
personal health data such as appointment
information, medications and lab results over an
internet connection.
► Some patient portals allow active communication
of the patients with their physicians,
prescription refill requests, and the ability to
schedule appointments.
► India is also adopting this changing trends in
healthcare, e-SanjeevaniOPD is a popular one
that can easily be downloaded from the play
store.
Master Patient Index (MPI)
► A master patient index is a system in healthcare that creates a single identifier
for each patient to link their medical records across different departments or
facilities.
► Master Patient Index (MPI) links different patient records through databases.
► The index maintains a record of every client that is registered at the health care
facility and indexes all other records for the client.
► MPIs are helpful in reducing record duplication and erroneous patient
information that can lead to the denial of claims.
Master Patient Index (MPI)
Why Organizations Must Implement MPI ?
► Paper format or electronic format, the important thing is that it should accurately
store an individual's actions or their treatment cycle.
► The primary purpose of MPI is to retrieve information about a specific individual
quickly without manually searching for it. MPI works by collecting vital
information such as their date of birth, gender, name, etc., and lastly, they provide
a distinct identifier to each individual.
► This information is essential in Interoperability. Implementing MPI will make your
medical software able to communicate - retrieve or update the correct patient’s
data
Practice Management Software
► Practice Management Software is designed to manage the administrative
functions those are done on daily basis like registration of the patient or
scheduling an appointment or the patients billing.
► A PMS helps automate and streamline tasks, freeing up staff for more important
things like patient care.
► Appointment Scheduling: Manage appointments, send reminders, and see
patient availability at a glance.
► Patient Records: Store and organize patient demographics, medical history,
allergies, and medications in one secure place.
► Billing and Claims: Generate invoices, submit insurance claims electronically, and
track payments.
► Reporting and Analytics: Get insights into practice performance, identify trends,
and make data-driven decisions.
► Communication Tools: Send secure messages to patients, send appointment
reminders, and manage internal communication.
Remote Patient Monitoring
► Remote patient monitoring (RPM) lets healthcare providers track a patient's
health data from their own home, instead of needing them to come into the
clinic all the time. Imagine a doctor keeping an eye on your vitals from afar!
► The Remote Patient Monitoring (RPM) system is the one that provides health
services to the patients setting in remote (distant) areas, which is known as
“Telehealth”.
► If nursing services are delivered through the use of telecommunication, it is
known as “Telenursing”
Advantages of HIS Disadvantages of HIS
Helps in integration of patient's data Cost consuming/expensive
Time saving Requires skilled personnel for operating the system
Increases interoperability Requires special faculty for teaching the trainees
Facilitates prompt treatment Regular updating of software required
Enhances the accessibility to data Causes over dependency
Health professionals may resist to change as it takes time
Generation of faster medical alerts
to learn new skills
Reduces the chances of faulty entries Threat to privacy and confidentiality
Improves patient safety Risk of hacking
Prevents duplication of work Lack of standardized protocols in the country
Supports standardized data collection Technical problems may be encountered now and then
Better documentation
Can store unlimited data
Proper management of records
Recent trends in health information system
► Recently The government of India launched Ayushman Bharat Digital Mission to
provide a digital health ID to people which will contain their health records. This
will enable access and exchange of health records of citizens with their consent.
ONLINE SERVICES
National Health Portal
► The National Health Portal is a single point access for authenticated health
information for citizens, students, healthcare professionals, and
researchers in India.
► It aims to provide detailed information on various health-related issues such
as diseases, health services, tips for healthy living, health programs,
insurance schemes, health apps, and widgets.
► The portal also offers helpline numbers and blood bank details.
ONLINE SERVICES
e-Hospital
► E-Hospital is a workflow based Integrated HMIS over cloud, e-Hospital is a
generic application, which addresses all the major functional areas of a
hospital.
► integrated with Ayushman Bharath Digital Mission (ABDM) ecosystem
ONLINE SERVICES
Online Registration System
► Online Registration System (ORS) is a framework to link various
hospitals across the country for online appointment system for getting
consultation where counter based OPD registration and appointment
system through Hospital Management Information System (HMIS) has
been digitalized.
► The application has been hosted on the cloud services of NIC. Portal
facilitates online appointments with various departments of different
Hospitals using ABHA(Ayushman Bharat Health Account).
ONLINE SERVICES
Mera Aspataal (Patient Feedback) Application
► Mera Asptaal is a simple, and multi- lingual application that
captures patient feedback in a very short time on the services
received from public hospitals.
► It works through multiple communication channels, including Short
Message Service (SMS), a mobile application, and a web portal.
ONLINE SERVICES
Central Drug Standards Control Organization, “SUGAM”
► The Central Drugs Standard Control Organization (CDSCO) is responsible
for regulating drugs and cosmetics in India.
► CDSCO has introduced an e-governance solution called SUGAM to
facilitate online applications for various services such as permission to
manufacture, import, or conduct clinical trials of drugs and cosmetics.
► The portal also provides a provision to raise queries or concerns through a
ticketing system.
► Manufacturers can add their formulation data on the SUGAM portal, and
firms can request to test vaccine samples and receive batch release
certificates online.
ONLINE SERVICES
Food Safety and Standards Authority (FSSAI)
► The Food Safety and Standards Authority of India (FSSAI) is an
autonomous body that governs and monitors most of India's
food-based operations and businesses.
► The FSSAI is responsible for ensuring that all food-related laws are
being followed by food business operators in India. The FSSAI also
conducts research on food safety and nutrition.
ONLINE SERVICES
National Organ and Tissue Transplantation Organization (NOTTO)
► National Organ and Tissue Transplant Organization (NOTTO) is a
National level organization set up under Directorate General of Health
Services, Ministry of Health and Family Welfare, Government of India.
► National Network division of NOTTO would function as apex centre for All
India activities of coordination and networking for procurement and
distribution of Organs and Tissues and registry of Organs and Tissues
Donation and Transplantation in the country.
Mobile Applications
Vaccine Tracker (Indradhanush Immunization)
► Mission Indradhanush is a health mission of the Government of India. The
scheme this seeks to drive towards 90% full immunization coverage of India.
Mobile Applications
India Fights Dengue
► Applications that helps to check dengue symptoms.
► Users can get nearest hospital / blood bank information.
► Users can add feedbacks, etc.
Mobile Applications
NHP Swasth Bharat
Swasth Bharat is a mobile application that provides information on
healthy lifestyles, disease conditions, symptoms, treatment
options, first aid, and public health alerts. It is part of the
National Health Portal’s operations.
Mobile Applications
NHP Directory Services Mobile App
► Directory Services mobile application that provides information related to
hospitals and blood banks across India.
Mobile Applications
No More Tension Mobile App
► Stress management application not only provides you
information about stress but also helps you to know
your stress level.
Mobile Applications
Pradhan Mantri Surakshit Matritva Abhiyan
► PMSMA App is a platform for volunteer
engagement and participation under the
Pradhan Mantri Surakshit Matritva Abhiyan
Programme.
► The application is an avenue for registration
of private sector/voluntary sector/retired
obstetricians, radiologists and physicians
willing to provide free antenatal services to
pregnant women at Government Health
Facilities on 9th of every month.
► It is also a platform for receiving their
feedback and creative suggestions.
Service Delivery and Tracking
► Mother and Child Tracking system/ Reproductive Child Health Application
► Kilkari - Kilkari is a mobile health education service that provides pregnant
women, new mothers, and their families with timely, accessible, accurate
and relevant information about Reproductive, Maternal, Neonatal and Child
health.
► TB Patient Monitoring System “Nikshay” - is a web enabled application,
which facilitates the monitoring of universal access to TB patients’ data by all
stakeholders.
► Tobacco Cessation Program - Tobacco cessation programs are interventions
that help people quit smoking, tobacco, or nicotine use.
► mDiabetes Program - The mDiabetes program to educate millions of people
in India about diabetes prevention through healthy living. It is the largest
text/voice message-based diabetes prevention program in the world
Process Automation
► Hospital Information System (HIS) – e-Sushrut
► ANM on Line (ANMOL) - Auxiliary Nurse Midwife (ANM) Online is an initiative of
the Ministry of Health & Family Welfare for ensuring delivery of full spectrum
of healthcare and immunization services from Eligible Couple to pregnant
women and children up to 5 years of age.
► Drugs and Vaccine Distribution Management System (DVDMS) – eAushidhi
deals with the supplies of drugs and vaccines
► eRakt Kosh - e-Rakt Kosh enforces Drug & Cosmetic Act, National blood policy
standards and guidelines ensuring proper collection & donation, effective
management and monitoring the quality and quantity of the donated blood.
MIS and Surveillance
► Health Management Information System (HMIS)
► Integrated Disease Surveillance Program (IDSP) - IDSP is a nationwide disease
surveillance system in India incorporating both the state and central
governments aimed at early detection and long term monitoring of diseases
for enabling efficient policy decisions.
► NHP Central Dashboard
Standards and Regulations
► National Digital Health Authority (NDHA) - The National Digital Health Mission
(NDHM) aims to develop the backbone necessary to support the integrated digital
health infrastructure of the country.
► EHR Standards
► Meta Data and Data Standards (MDDS)
► National Resource Center for EHR Standards (NRCeS)
► National Identification Number (NIN)
Capacity Building
► Mobile Academy - Mobile Academy is a free audio training course designed to
expand and refresh the knowledge base of Accredited Social Health Activists
(ASHAs) and improve their communication skills. Mobile Academy offers ASHAs a
training opportunity via their mobile phones which is both cost-effective and
efficient.
► Training Management Information System (TMIS) -The purpose of the TMIS is to
create a web based application for a nationwide database of skilled and trained
human resource to strengthen the public sector health delivery system.
Online Consultation – Tele-medicine
► National Medical College Network – National Telemedicine Network
► SATCOM Based Telemedicine Nodes