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QUALITY TOOLS FOR SERVICE DELIVERY

CLINICAL-HEALTH: COMPUTER APPLICATIONS FOR THE
MANAGEMENT/ADMINISTRATION OF THE UNIT/OFFICE AND FOR
THE TREATMENT OF CLINICAL DATA.

0. INTRODUCTION
TOOLS QUALITY OF CLINICAL-HEALTH SERVICE PROVISION________2
Applications COMPUTERS. BASIC CONCEPTS________________________________4
3. APPLICATIONS MANAGEMENT/ADMINISTRATION INFORMATICS________________________5
3.1. MANAGEMENT AND WAREHOUSE CONTROL__________________________________________________5
3.2. BILLING___________________________________________________________________6

4. APPLICATIONS COMPUTER SCIENCE FOR THE MANAGEMENT OF CLINICAL DATA______________7

4.1. TREATMENT GENERAL CLINICAL DATA_________________________________________7
4.2. APPLICATIONS FOR ADMISSION MANAGEMENT_______________________________________8
4.3. APPLICATIONS FOR THE MANAGEMENT OF MEDICAL RECORDS_______________________________8
4.4. APPLICATIONS FOR PRIMARY CARE____________________________________________9
4.5. DIRAYA

5. EXAMPLE DE COMPUTERIZATION OF A HOSPITAL RADIO DIAGNOSTIC UNIT.

HIS/RIS/PACS___________________________________________________________________10
6. LEGISLATION ABOUT COMPUTERIZED CLINICAL DATA____________________________11
7. MEASURES ON SECURITY______________________________________________________11

8. CONCLUSIONS______________________________________________________________12
9. BIBLIOGRAPHY AND WEB PAGES_________________________________________________12

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 Topic 21. Computer Applications

0. INTRODUCTION
The description of computer applications as a quality tool for service delivery
clinical-sanitary service appears in the curriculum of all titles of the Professional Family
of Health, as outlined in the regulations that govern them: vocational training cycles of degree

superior of Clinical Diagnostic Laboratory (D. 40/1996), Environmental Health (D. 41/1996)
Dental Prosthetics (D. 43/1996), Orthopedic Prosthetics (D. 474/1996), Radiotherapy (D. 475/1996) and Imaging
for the Diagnosis (D. 381/1996) and the intermediate vocational training cycle in Pharmacy and Parapharmacy

(Order of October 15, 2009). Knowledge about computer applications of

management/administration and treatment of clinical data and basic legislation on clinical data
Informed, they will help achieve the general objectives set in each chapter.

1. QUALITY TOOLS FOR CLINICAL SERVICE DELIVERY

SANITARY
During the 1960s and 1970s, the main objective of health systems
Western countries aimed to provide basic assistance benefits to the entire population. Currently,
its main challenge lies in ensuring the survival and economic viability of these systems.
improving their quality in aspects such as efficiency and equity. Gradually,
elements typical of business management are introduced, implementing quality policies
customer-oriented based on the principles of continuous improvement.

At the International Conference on Primary Health Care in Alma-Ata, organized

by WHO and UNICEF, the importance of systematic monitoring of quality is highlighted
sanitary services, especially in Primary Care.

The quality of care can be defined as the satisfaction of needs (both real
as perceived) by the patient-clients with the lowest resource consumption. Good quality
assistance would be one in which patient care is developed according to the most precise
and updated scientific knowledge, with a correct practical application and with a contract
considered personal.

The highest quality is achieved if the individuals providing the assistance possess
adequate and updated knowledge, they apply it correctly, they have the resources
indispensable technologies and consider the patient as the protagonist of their work, that is,
like a genuine client who seeks a health service, even when being able to choose others.

The complete care quality would be the result of two components:

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 Topic 21. Computer applications

Intrinsic or scientific-technical quality: problem-solving capacity of the health issue

through knowledge and technology. It is the most valued component by the
healthcare professionals. It is very similar across different healthcare centers.

Extrinsic or perceived quality: user satisfaction regarding the service received.

Humanitarian component that integrates treatment, information, environmental conditions,
the facilities and hospitality. It is usually the most valued component by the patient.
cliente. Es elfactor diferencial entre los centrosdesde la óptca del cliente.

To achieve the highest levels of intrinsic and extrinsic quality, it must be applied.
permanently the methodology specific to continuous improvement processes. This includes the
development of different computer solutions to facilitate the work of professionals
health, optimize the management of centers and ultimately improve the quality of care.

The Quality Plan for the National Health System includes the use of technologies.
from the information in the National Health System to improve care for citizens. A
One of the strategies for its development is the project 'Online Health' within the Avanza Plan.
Government that seeks to generalize the use of technologies in Spanish society.

The member states of the European Union have committed to sharing their best.
practices and experiences to create a European Space for electronic health, thus improving it.
access and the quality of care, through the European Action Plan for electronic health.
Europe is dedicating efforts to the development of standards and norms for achieving the
electronic medical record (EMR). The technical committee 251 (Health Informatics) of the European committee
The normalization (CEN/TC 251) is responsible for developing these standards in IT.
sanitary and communications. One of the standards developed is CEN EN13606, approved
by the ISO (International Organization for Standardization), whose main purpose is to allow the
communication of HC between heterogeneous systems. At the same time, in relation to the informatics of the

Health, there are numerous quality standards, such as ISO/TS 21547:2010.

The national mirror committee of CEN/TC 251, the CTN 139 of AENOR, also works on standards.

important in this field, such as the 13606 (transfer of health information), the 13940
(system of concepts for continuity of care), the family 11073 (communication of
devices), the 12967 (service architecture), and the start of our work related to the
pharmacovigilance, personal health information records, among others.

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 Topic 21. Computer Applications

There are also other quality agencies, such as the Health Quality Agency of Andalusia.
(ACSA), which is an organization of the Health Department of the Junta de Andalucía created to
promote and guarantee the quality and continuous improvement of all health services, with
accreditation programs for Centers of the Health System of Andalusia (ME 2 1_04) that
meet certain quality standards.

On the other hand, HL7 is an international organization that aims to promote development and
evolution of the HL7 (Health Level Seven) standard for data format and exchange
information between different Health Information Systems.

2. COMPUTER APPLICATIONS. BASIC CONCEPTS

Before analyzing the computer applications used in the different units/cabinets
Sanitary workers, we are going to discuss some basic concepts about computer applications.

Software: it is the logical support of a computer and can be classified into three large types:

- System software: the operating system, which enables communication with the
machine and the other programs run on it. For example, Windows, Linux, etc.

- Programming software: tools that allow the programmer to develop

programas informátcos, con diferenteslenguajes de programación(Java, C++, etc.).

- Application software or computer applications: that which allows users

carry out specific tasks, in any field of activity susceptible to being
automated. They can be general-purpose applications or specific-use applications.

General-purpose computer applications (office suites): useful computer programs

for administrative work, which serve as basic tools in management
(word processors, spreadsheets, database managers, etc.).

Specific clinical management software applications: computer programs

specific tools used for the clinical management of small clinics and practices,
for the management of primary care, specialized care, or medical records
(HC) in any healthcare setting (public and private). The healthcare institutions of
Medium and large sizes have powerful software programs and extensive networks.
of computers to carry out their activities (preparation, management, and filing of medical records,

admission and appointment scheduling for consultations, management of health warehouses, billing for care

sanitary, etc.). Some commercial examples of these applications are the following:
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 Theme 21. Computer Applications

SALUS: software for the comprehensive management of clinics, medical centers, and hospitals.

Medical software Axon (from Medigest).

FLOR: Nursing Planning and Management Units Information System

Hospitalization, installed in SAS hospitals, such as H. Reina Sofa, in Córdoba.

Virtual dental: useful application in dentistry and dental prosthetics for virtual recreation
from the mouths of patients or virtual Set-Up simulations for orthodontics.

These IT applications for clinical management are developed in detail in the

Sections 3 and 4 of the topic. Later, in section 5, we will discuss an application.
concrete for the Radiodiagnostic Service of a hospital.

3. INFORMATION TECHNOLOGY MANAGEMENT/ADMINISTRATION APPLICATIONS

3.1. WAREHOUSE MANAGEMENT AND CONTROL

We distinguish two types of software applications, one for hospital centers and another for
consultations with healthcare professionals:

Computer applications dedicated to the control of hospital warehouses

Also called supply management software applications. These applications are

designed specifically for these warehouses and can be part of an application
integrated, that serves for the management of the entire hospital. Works with data related to:

Articles: organized in a catalog according to group, subgroup or family.

Suppliers.

Warehouses and sections of the warehouse.

-Functional service homogeneous groups of the hospital (GFHs: each of the

hospital units that consume products of a certain class.

The information is organized in the form of master files, and once these are defined, the
aplicación permite las siguientesfunciones:

Control and evaluate the inventory.

Prepare the warehouse management documents: warehouse cards, inventory, etc.

Control the suppliers' offers and the hospital's orders.

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 Topic 21. Computer Applications

Facilitate the procedures that accompany the receipt of goods in the warehouse.

Control the orders that the GFH make to the warehouse and perform an analysis of consumption.

Computer applications for the management of a small cabinet's warehouse

They can be general warehouse control applications adapted to a sanitary cabinet.

There are applications that integrate billing and warehouse management. In one application
Information of this type is proceeded in the following way:

When a specific item arrives at the warehouse, it is entered into the database.

When a buy-sell operation of an item occurs, the application allows

generate the relevant documents (budget, delivery note, invoice), which can
personalize. When issuing an invoice, the application deducts the items, so
allows to control the stocks.

3.2. BILLING
In general, a typical billing application includes the following functions:

Allows you to verify the letter of the NIF and check the number of a credit card.
corresponds to one of the cards issued by the corresponding issuing entity.

The due dates of an invoice can be defined for installment payments.

They allow you to perform mailing operations to send letters to customers from a
unique text and a database with the names and addresses of them.

Data files include the data of items, customers and the

suppliers. The application creates a file for each item, customer, or supplier.
Some of the data that is usually filled in the data files are:

File of articles or services: code, group keys, subgroup or family, units

for measurement, data for stock control and inventory valuation (reorder point,
weighted average price, etc.), increase (% added to the cost price), etc.

Customer file: code, identification data, address, NIF, banking data,

discounts, etc.

Supplier file: code, identification data, address, NIF, banking data.

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 Topic 21. Computer Applications

Just like in the case of warehouse management applications, a distinction is made between the

applications for private hospital centers and those of healthcare professionals' consultations:

Invoicing information in private hospitals: includes the following operations:

Definition of a series of master files with information about the entities

insurance companies that the hospital works with and the different rates of each entity.

Control of the services and interventions carried out on the patient in the various areas.

Issuance of the corresponding invoices.

Billing applications used in consultations by healthcare professionals

They are organized on a database (files, documents or master files), that is

fill in the data related to suppliers, customers, and items.

They allow invoices to be printed in a personalized way.

4. COMPUTER APPLICATIONS FOR THE TREATMENT OF CLINICAL DATA

4.1. GENERAL TREATMENT OF CLINICAL DATA

The management of medical and administrative data is facilitated through the use of
computer applications, whether of a general nature or for specific use:

General-purpose computer applications are, for example:

Database managers (Access, MYSQL, etc.): allow archiving and retrieving data
in an organized manner, print listings, perform mailing operations, etc.

Word processors (Word Perfect, Word, Open Office Writer, etc.): can be used
to prepare reports, define the format of a text, add images, tables, etc.

-Spreadsheets (Lotus, Excel, Open Office Calc, etc.): can facilitate the work of
billing, allow performing mathematical operations, graphical representations, etc.

Applications to create visually appealing presentations (PowerPoint).

The main software manufacturers publish integrated packages of these applications.

with the advantage that data can be exported from one application to another.

Specific computer applications: in the following sections we will review

some general characteristics of three different typical applications, such as those of
admission management, health care management, and applications in Primary Care.
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 Topic 21. Computer Applications

4.2. APPLICATIONS FOR ADMISSION MANAGEMENT

Healthcare centers tend to use computer applications that are responsible for the
integral management of the same. These integral applications work through modules,
dedicated each of them to an area: admission, pharmacy, pathological anatomy, billing, etc.
Everyone is interconnected so that information can be shared.

Admission applications can be characterized, among other issues, by the following:

They are interconnected databases in which information is being entered.

Master files that are files in which basic information is entered to which we
It gives a code. There will be a file with all the services and units of the center, another with

all the doctors, another one for consultations, another for beds, etc.

They group all the data of a certain patient in their medical record. One of the modules will be,

Well, the one from HC. Each story will be identified by a number.

They facilitate the medical-administrative work related to: patient waiting lists,
citation, patient income, etc.

4.3. APPLICATIONS FOR THE MANAGEMENT OF MEDICAL RECORDS

Healthcare management applications generally have the following functionalities:

1. Creation or opening of a HC: each HC is assigned a code or number of

identification. The patient's personal details (first name and last name) must be filled out.
date of birth, health insurance, etc.), which are stored in a "membership record."

In each story, various 'cards' can be opened that correspond to the various
contacts that are had with the patient: general history, physical examination,
radiological explorations, treatment, etc. In this way, all the patient's data
they appear grouped in their HC, with health data constituting the axis of organization.

3. Each patient ’s health record and the health record as a whole must be able to be filled out at once.

first, to be consulted later, to be corrected, to be printed or erased.

4. Search for the patient's medical record: either by name and surname or by the medical record number, or by

through a list of all patients.

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 Topic 21. Computer Applications

5. The various signs and symptoms of a patient and the possible diagnoses may be
previously coded. A list will appear on the screen for you to select them,
manera que las diversas posibilidades serán escritas siempre igual.

6. They allow managing an appointment schedule for one or more healthcare professionals.

The electronic health record (EHR) or digital presents numerous advantages: it makes possible a
true unique HC in the SNS, facilitates the permanent update of clinical data, simplifies
file areas and facilitates administrative work, among others. However, it also
presents certain drawbacks: the obvious risk of security being compromised and
confidentiality of clinical data, the strong financial investments it requires, or possible
technical problems. Despite the inconveniences, the use of means is becoming widespread.
information is such that the European Shared Health Care is planned for 2015.

4.4. APPLICATIONS FOR PRIMARY CARE

The focus of work in primary care is the person who comes to the consultation and this is also
the axis around which a primary care computer application is organized. Each patient
receive a code that can be used to search all the information that is held about him. This
information will include affiliation data, health programs in which it is included, allergies and
Notes about all the consultations that the patient has had with the doctor. The data of each
Consultations can be organized according to some models used in primary care, by
example, the SOAP model (S: subjective data or symptoms, O: objective data or signs; A:
diagnostic approach, P: action plan). The informatics facilitates the coding of the
consultation situations, being able to use the WONCA codes (International Classification of
Primary Care) or EDO (List of Diseases of Mandatory Declaration). In addition, they can
to sign up: the actions carried out (request for analysis, radiological studies, etc.), the
prescribed medications and their dosing, the employment situation in which the patient is left, etc.

At the end of the medical consultation, time is saved in the preparation of the documents and
They can print what is required: prescriptions, interconsultation requests, analysis, diagnosis by
the image, nursing actions, justifications for assistance, situation change reports
labor, etc. In addition, these applications allow for the gathering of information about the
problems and treatments of patients, which statistically allows for improvement
practice of primary care.

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 Theme 21. Computer Applications

4.5. DIRAYA
DIRAYA is the system used in the public health system of Andalusia as support.
of the HCE. Integrated health information of each citizen, to which professionals
they can access from any Andalusian center, and it is used for the management of the health system. The
the solution is comprised of several modules, including the Citation module and the
Prescription. The backbone of DIRAYA is Microsoft technology.

DIRAYA has brought important innovations in the management of appointments with the family doctor and

the pediatrician, which can be requested through the Internet (InterSAS), via SMS and with the service

Health Response phone service. In addition, it has allowed the development of electronic prescriptions, a
Model of prescription and dispensing of medications through the health card.

5. EXAMPLE OF COMPUTERIZATION OF A HOSPITAL UNIT

RADIOLOGICAL DIAGNOSTICS. HIS/RIS/PACS

One of the first applications of computing and new technologies in the environment
Health care was carried out in the radiodiagnostic services. The activities associated with these services
they are the realization of the images obtained through the different diagnostic tests and their
posterior interpretation that gives rise to the clinical report. To incorporate the images into the medical record, it
requires an efficient acquisition system, which can be stored correctly and
safe, that they can recover quickly and that they can be viewed with quality.

More than 50% of the initial examinations conducted in radiodiagnosis on a patient

They are conventional X-rays. That is why the first step is to digitize conventional radiology.

Once this is done, the next stage to cover is the implementation of a system
communication and imaging archive (PACS), which allows the acquisition of images from different
modalities (CT, MRI, ULTRASOUND, etc.), their processing and the distribution of images and reports, as well

as file functions, diagnosis, and printing. For this, the PACS must be integrated with
a hospital system available at the healthcare center (HIS/RIS). The Information System
Radiological Information System (RIS) is an integrated management program for all the data of a Service

Hospital Radiology. The components of a RIS are divided into different areas or modules:

1) Programming area: contains all processes of citation, consultation of the

programming, generation of listings and work labels. Regarding identification
from the patients, the RIS could automatically connect with the Information System
Hospital (HIS) and make a request to obtain the administrative data of a
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 Topic 21. Computer Applications

patient. When HIS returns the data, it is automatically recorded in the table.
of RIS patients. This connection is made following an Exchange protocol
Electronic Data between Health Applications (such as DICOM or HL7). The module of
Citations in some solutions are part of the HIS, and in others, of the RIS itself.

2) Patient reception area: allows modification of the patient's 'status',

identification of urgent patients and generation of identification labels.

3) Area of examination: encompasses the processes of capturing activity that are carried out from each

exploration room: record of the explorations, identification of the personnel conducting them
realizes, radiation dose, etc.

4) Information area: allows for the completion and coding of reports. RIS
contains the A.C.R. coding system (from the American College of Radiology), its
expanded version, E-ACR or ECR, or other systems.

5) Control area: groups the cataloging of explorations, the programming of devices,

schedules, etc., the collection of data for statistical exploitation and access management.

6. LEGISLATION ON COMPUTERIZED CLINICAL DATA

Among the regulations related to the treatment of computerized clinical data, the following stand out:

Royal Decree 994/1999, which approves the Regulation of security measures of the

automated files that contain personal data.

Organic Law 15/1999 on the Protection of Personal Data (LOPD).

Law 41/2002, of November 14, basic regulating the autonomy of the patient and of

derechos y obligaciones en materia de información y documentación clínica.

7. SECURITY MEASURES
The use of computer applications facilitates work, but it is not without risks. The LOPD
consider health data as especially protected, so it must
prevent access, accidental or deliberate, to patient data (confidentiality). The
computer applications that handle clinical information must establish passwords for
access, and there must be different levels of permissions to access the program, remaining
record of the individuals who access and the information requested (traceability).

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 Topic 21. Computer Applications

In case the computer breaks down and data may be lost, they must
back up the main documents prepared.

Finally, teams can be affected by dangerous computer programs.

(malware), such as computer viruses,
Against these possible attacks, an updated antivirus program must be used, having
enable the firewall and follow the security advice of experts.

8. CONCLUSIONS
Ultimately, the description of computer applications as quality tools
The provision of healthcare clinical services is of significant importance in the curriculum.
corresponding to the higher level training cycles of Clinical Diagnostic Laboratory,
Environmental Health, Dental Prosthetics, Orthoprosthetics, Radiotherapy and Imaging for Diagnosis, and in
the vocational training cycle of intermediate level in Pharmacy and Parafarmacy. The computer applications of

general use serves as a basis and support for more specific applications on management, administration
clinical data treatment, which can be used in the different units and offices.

9. BIBLIOGRAPHY AND WEBSITES

Beltrán, A. (1998). A Information System for Radiodiagnosis. In: Informatics and
Health, No. 15. [Link]

Chavarría, M.; Mugarra, C. (2004). Digital Radiology: Image Acquisition. In:

Informatics and Health, nº 45. Monographic Digital Radiology.

Escolar, A.; Larrañaga, I. J. (2008). OADS. Madrid: Macmillan Profesional.

Mingo, G. (2009). OADS. Pozuelo de Alarcón: Editex.

Piédrola, G. (2008).Medicina Preventva y Salud Pública. Barcelona: Masson.

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htp://[Link]/healthqualityagencytaria/

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