When Hospital Information Systems (HIS) were first introduced in the ‘60s, the focus was limited to the core financial aspects of the business. This constraint was simply due to the high investment needed for mainframe computing and the network infrastructure for the HIS.
The 80’s brought new technology, including local area networks and PCs. This lower investment barrier provided the initial triggers for change. With that architecture change, hospitals had the capability to link disparate internal systems, creating a more encompassing approach to managing healthcare services within a facility. Shortly thereafter, wide area networking (WAN) enabled connectivity between different hospitals and clinics, forming the initial foundation for digital data sharing.
Data sharing brought new challenges. For data to be successfully shared between disparate hospitals and systems, the data format needs to be consistent and predictable. This is where Health Level Seven International (HL7) stepped in. HL7 provides an international standard for the exchange, sharing, and retrieval of electronic health information. Simply put, it is a protocol or agreement that enables better collaboration between multiple organisations and systems.
Creating sharable datasets
The adoption of HL7 in the industry led to more effective health information sharing, enabling the creation of a National Health Information network. As a working example, let’s look at New Zealand.
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, which is used to store all health information for that individual. This prevents data duplication, increases security around data access, and facilitates national data collection for analysis.
For 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 in their care. Utilising the HL7 standard for data transfer, health organisations and facilities caring for a patient can send updates to the NHI.
Traditionally, a patient’s Electronic Medical Record (EMR), including their medical history, tests, diagnosis, and treatments have been stored–and owned–by the facility that provided the treatment. The exchange of patient data between disparate facilities is often done using HL7 or the newer data format standard, Fast Healthcare Interoperability Resources (FHIR).
However, due to data validation and process disparities between systems, all data associated with a patient may not be fully integrated into a single reliable source. 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 record. These integrations are often done piecemeal, limiting the reliability of real-time access to the most current patient information. If a patient were to receive care from multiple facilities (perhaps due to a specialist referral, for example), care providers cannot be fully confident that the local copy of the patients’ EMR is fully up to date.
Maintaining a single source of truth
But what if all healthcare providers used a single, centralized system? If GP practices, hospitals, and community care providers all shared a single database, the result would be a single source of truth. Updates to the patient record would mean all changes are immediately accessible to all care providers. Not only would this remove the need for expensive custom integrations, but it would provide clinicians with confidence when making patient care decisions—ultimately facilitating better health outcomes.
The need for a centralised HIS is already high. Governments with public health schemes are constantly faced with an ever-growing ageing population, creating a shift from treating infectious diseases such as cholera and malaria to long term chronic conditions such as heart disease, diabetes, and cancer. This increase in demand is paired with reduced funding, a lack of medical care providers, and ever-increasing patient expectations. All of these challenges make the need for centralisation even greater.
Let’s take a brief look at how a single centralised HIS addresses five key issues for providers:
Enabling collaborative care
The era of specialty care is here. Patients commonly need to transfer to different facilities for specialised treatment, especially in cases where a patient requires specific treatment not offered at their local hospital. With a unified HIS, transfers and referrals across facilities are facilitated with ease.
Identifying needs for targeted funding
A centralised system with BI reporting capability allows for the analysis of service demand across different population cohorts. Diagnosis data can be captured and analysed across different patient demographics, ethnicities, and regions. Not only do these factors help ensure that public funding is appropriately distributed, they identify areas where early intervention, patient education, and preventative care programs would be of value.
Facilitating 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. The system facilitates collaboration by providing a comprehensive, longitudinal patient record, enabling the coordination of care. This is particularly vital in increasing the effectiveness of chronic disease management, such as the global diabetes epidemic.
Analysing big data
Big Data analytics in healthcare provides more detailed, personalised insights, allowing a shift to individualised patient care. Using artificial intelligent (AI) and rapid in-memory processing, these systems extrapolate outcomes from vast data sources. The analysis allows care providers to determine treatment options and their associated success probabilities based on cohorts of patients sharing the same demographic, diagnosis, and treatment plan.
Shifting to precision medicine
The approach to healthcare is radically changing worldwide. Where care providers used to focus on understanding and treating disease, they are shifting toward an individualised, patient-centric care model.
Through the Human Genome Project, providers have come to understand the importance of genetics when making clinical decisions. In the last few years, costs for genetic testing have plummeted, as advances in sequencing technology have made individual genome sequencing economically feasible. Remarkable advances in genomics technologies, including pharmacogenomics and direct-to-consumer genomics, are leading to large pools of stored patient data.
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. To revolutionise the model to precision care, providers need to have access to all the relevant health determinants for a patient, which include social, cultural, financial, behavioral and economic data.
Modernising your HIS
Centralisation begins with modernising the HIS. When looking to replace or employ an HIS system, the first step is to understand the different solutions and their current capabilities as well as their positioning for the future of precision medicine. To learn more about HIS selection and adoption, download the white paper, “HIS For Everyone: A Guide for Hospital Information System Adoption by Hospitals of All Sizes.”