What do you need to know?
When Hospital Information Systems (HIS) were first introduced, in around the 1960’s, the focus was constrained primarily to the core financial aspects of the business. This limitation was imposed not for lack of ingenuity, but simply due to the high investment cost of mainframe computing and lack of network capability.
The 80’s brought increased availability of local area networks (LAN), the introduction of smaller personal computers and a lower investment barrier, providing the initial triggers for change. Vendors were now able to link disparate internal systems allowing a more encompassing approach to the management of healthcare services within a facility.
The introduction of the Wide-Area Network (WAN), enabled connectivity between different hospital sites, forming the initial foundations for digital data sharing. Tech now provided us the ability to send and receive data electronically. Having the capability to transfer data from one system to another is not enough in itself. For data to be successfully shared between disparate hospitals and data systems, the data format needs to be consistent and predictable. System A and System B need to understand data in the same way - this is where Health Level Seven International (HL7) stepped in to fill the gaps. HL7 provides an international standard for the exchange, sharing and retrieval of electronic health information. It is simply a protocol or agreement that enables better collaboration between multiple organisations and systems.
The adoption of HL7 facilitated standards in sharing of health information, enabling the creation of a National Health Information Network. Let’s look at New Zealand as an example.
The NZ Ministry of Health (MoH) provides a national dataset for all patient demographic data, known as the National Health Index (NHI). The premise of NHI is that every patient has a single national identifier to be used to store all health information for that individual. This prevents data duplication, increases security around data access and facilitates national data collections for analysis. For the concept of a national index to work, healthcare providers accessing patient data need to act as data stewards – updating any demographic information that may have changed for a patient. Utilising the HL7 standard for data transfer, health organisations and facilities are able to fire update messages off to the NHI.
Traditionally, a patient’s Electronic Medical Record (EMR) – that is their medical history – tests, diagnosis, treatments etc. have been stored and ‘owned’ by the facility that provided the treatment. The exchange of patient data between disparate facilities is often facilitated again using standards like HL7 or Fast Healthcare Interoperability Resources (FHIR) – however due to data validation and process disparities between different systems, we often fail to facilitate a deep copy of patient data. Any integrations require a significant amount of custom mapping to ensure the data sent by the publishing system is correctly validated and inserted into the subscriber. These integrations are often undertaken in a piecemeal fashion limiting the reliability of real-time access to up-to-date patient information. In a nutshell, if a patient was to receive care from multiple facilities (perhaps due to a specialist referral for example), care providers could not use the local copy of the patients’ EMR to make clinical decisions with confidence.
But what if all healthcare providers across the continuum made use of a single, centralised system? If GP practices, hospitals, community care providers all made use of a single database – a single source of truth. Anyone providing care for a patient, updates the patient record and any changes are immediately accessible. Not only would this remove the need for expensive custom integrations, but it would provide clinicians with confidence when making any decisions on patient care – ultimately facilitating better health outcomes for all.
Governments with public health schemes are constantly faced with an ever-growing aging population, a shift from treating infectious diseases like cholera and smallpox to long term chronic conditions such as heart disease and cancer. This increase in demand is paired with reduced funding, a lack of medical care providers and ever-increasing patient expectations. In order to meet demand, health systems need to increase efficiencies by reducing waste, enabling faster treatment times and improving patient outcomes.
Let’s take a brief look at how a centralised, single HIS deployment addresses these issues.
Enabling collaborative care
It is rather common for patients to need transfer to different facilities for treatment. Especially in cases where a patient requires specialist treatment not offered at their local hospital. With a unified HIS, transfers and referrals across facilities is facilitated with ease.
Targeted funding for identified needs
A centralised system with BI reporting capability allows for the analysis of service demand across different population cohorts. Enabling the analysis of diagnosis across different patient demographics, ethnicities, regions etc. Not only do these factors help ensure that public funding is appropriately distributed – they also identify areas where early intervention, patient education and preventative care programs would be of value.
Population Health Management
A system that links both administrative and clinical information across multiple care sectors enables quick access and data sharing between primary, secondary and community care providers. Facilitating collaboration by providing a comprehensive, longitudinal patient record, enabling the co-ordination of care - increasing the effectiveness of chronic disease management.
Big Data Analysis
Big Data analytics in healthcare provides more detailed, personalised insights allowing a shift to individualised patient care. These systems extrapolate outcomes from vast data sources, to provide treatment options and their associated success probabilities based on cohorts of patients sharing the same demographic, diagnosis and treatment plan.
The approach to healthcare is radically changing worldwide. Where we used to focus on understanding and treating disease, we now realise the power of providing individualised, patient-centric care. Through the Human Genome Project, we have come to understand the importance of considering genetics when making clinical decisions. Sequencing of the DNA can help us understand diseases, including genotyping of specific viruses to understand the best treatment plans for the individual, identification of mutations linked to different forms of cancer, an understanding of the likely effects of specific drugs and more accurate prediction of outcomes for the individual.
Genomic data is not the only non-clinical data relevant to health however. If we really are to revolutionise healthcare, we need to be looking at all the relevant health determinants which include social, cultural, financial, behavioral and economic data.
When looking to replace or employ an HIS system, it is worthwhile understanding the vendors current capability in comparison to the market – but also their positioning for the future of precision medicine.
To learn more about HIS selection and adoption click through the button below and follow the steps to download our white paper ‘HIS For Everyone’.