Intranet Technology in Hospital Information Systems

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Intranet Technology in Hospital Information
Systems

• James J. Cimino, M.D.
• Department of Medical Informatics
• Columbia University

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Accessing Clinical Information over the Internet
and World Wide Web

• James J. Cimino, M.D.
• Department of Medical Informatics
• Columbia University

3
Web Access to the EMR atColumbia-Presbyterian
Medical Center

• James J. Cimino, M.D.
• Department of Medical Informatics
• Columbia University

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CPMC in 1988 - preTCP/IP
IBM Mainframe
Data Repository
Data Monitor
Vocabulary Server
Results Review
Ancillary Systems
Clinicians
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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
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CPMC in 1994 - WWW
IBM Mainframe
Data Repository
Data Monitor
Intranet
Minicomputer
Web Server
Internet
Internet
Vocabulary Server
Knowledge Resources
Clinicians
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Clinical Database

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

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Data Monitor - Input and Alerts

• Stores all data in repository
• Checks data for triggers
• Executes Medical Logic Modules
• Stores alerts in database

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Clinical Database Server - Output

• Dynamic queries (SQL)
• Canned queries
• Time span
• Last "n" results
• Class-based retrievals ("get all positive
  culture results")

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Medical Entities Dictionary (MED)

• 56,000 medical concepts
• 82,000 synonyms
• Multiple hierarchy (72,000 links)
• Semantic network (43,000 links)

Calcium Preparations
Intravascular Calcium Tests
Abnormalities of Calcium
Calcium
Hypercalcemia
Hypocalcemia
Serum Calcium
Plasma Calcium
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MED Server

• Lexical searching
• Concept attributes
• Classes
• Ancestors

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Web Server

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

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CPMCs Web EMRs

• Elpis - single patient view
• PolyMed - service view
• WebCIS - multiple views

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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

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screen shots

• alerts
• cardiology - detail
• ecg
• multi-patient summary
• lab order entry
• pharmacy list
• pharmacy rx
• time view

• patient list
• departmental screen
• headers - lab
• details - lab
• lab summary
• lab graph
• radiology - detail
• dop - detail

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Integration of On-line Resources

• Lab to Medline
• Lab to PDR
• Lab to disease description (DXplain)
• Lab to differential diagnosis (DXplain)
• Lab to guideline (cholesterol)
• Drug to dietary restriction information
• Drug to PDR
• X-ray to Medline
• X-ray to Web information sources

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screen shots of integration

• Lab to disease description (DXplain)
• Lab to differential diagnosis (DXplain)
• Lab to guideline (cholesterol)
• Drug to dietary restriction information
• Drug to PDR
• X-ray to Medline
• X-ray to Web information sources

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Security and Confidentiality

• User logon name and password
• Encryption (SSL)
• Logon screen ID (single use)
• Session screen ID (expires)

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Current Challenges

• Application development
• Navigation of hypertext
• No control over client machines
• Resource integration
• Hospital mergers

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parting shot - carmen sandiego lab