Types of hospital information systems

The hospital information system has become an integral part of health care. It is linked to the health informatics that focuses mainly on the administrative functioning of hospitals and clinics/nursing homes. It has different implementations and is an integrated and comprehensive information system designed to deliver every administrative operation in the healthcare industry.

Hospital information systems in recent years have been converted into digitized systems involving computers, while the traditional file cabinets and paper works are taking a backstage. A computerized health information system is made up of steps such as data input, processing, outputs, and boundary. The computer system receives the health data, which then get processed to finally produce the specified outputs, and there are predefined boundaries to influence the outputs.

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The aspect of processing involves monitoring as well as memory functions. The digitized health informatics system is associated with the idea of a wide range of aspects. For instance, the healthcare organizations, the medical professionals, and the mortuary are part of the health system. All these systems comprise a clearly defined boundary. As an example, you can consider that the grocery shop cannot be a part of the health care system.

The input, processing, and output changes with the purpose of a system and it is usually felt that certain system models can be based on the input aspects, which will eventually influence the processing and output. However, the design of most information systems is based on the outputs.

Let us discuss the types of health information systems the current healthcare industries are using and different perspectives of these systems.

Types of health information system

Subject and Task-based Health Information Systems: Health information systems can either be subject-based or task-based. The subject-based health information system is related to any type of health care organization (patient or healthcare professionals), whereas the task-based health information system is associated with particular tasks (admissions/ discharge system or operating theatre).

According to James Martin (1981), subject-based information systems work better than task-based systems because they reduce the possibility of data duplication. This is because of the fact that, in a task-based information system, the same subject undergoes different tasks; the basic details (such as name or address) would get collected each time. But, in the subject-based information system, basic data get collected only once and flows into different tasks. Electronic health/patient record (EHR/EPR) can be regarded as an example of the subject-based information system.

Strategic or Operational Health Information Systems: Use of strategic or operational health information systems is one of the most common methods of classifying the health information. At every level of this health information pyramid, provisions are made for information systems dealing specifically with that type of information. This type of pyramid classification of information system has many advantages over other methods of classification. The main advantages of this type of information system are:

• It allows the assessment of an organization regarding the spread of digitization in its information system. This can easily be achieved as the operational systems are generally developed before the formation of executive information systems or management information systems.
• It permits the highlighting of inappropriate or uneven development in systems. This can be fulfilled by considering the dependency of hierarchical data that the management information systems need to feed to the operational system.

One has to consider the dependencies to identify the individual system deficiencies. Let us look at some examples of such approaches below:

• A digitalized planning tool developed in the UK will provide output information related to possible hospital requirements in the future by projecting the capacities of the hospital and information regarding the waiting list. The drawback of this system is that it does not have the feeder system necessary to keep it up to date.
• Every hospital faces problems while solving cost issues in the UK because that had to be carried out by top-down apportioning. This is because of the lack of any feeder system to provide information on exact per-client usage. However, this is not a problem in American hospitals that has the feeder system used in billing.
• Many hospitals have management systems for nurses and a manual data collection approach is often employed to maintain the system. However, a proper information system should get such information directly from a clinical system.

Clinical and Administrative Health information Systems: Clinical and administrative health information systems represent another division of health information systems. However, it is practically impossible to develop a clinical system that is not dependent on various types of administrative data. As an example, one may consider the most critical clinical systems that must allow the production of patient or GP to follow-up the address details of GP.

The foundation of an integrated health information system is more of a master index developed around the most basic patient information (administrative information) giving links to different clinical systems. All departmental healthcare systems therefore allow individual patients to set up an additional research dataset to carry forward specific activities. Every clinical system actually contains electronic patient records (EPRs), which contain the digitized patient information.

All the hospitals now have a patient administration system that provides information in the form of hospital episode statistics and its reports to the DOH. It can be regarded as an administrative system because it is designed to make provision for retrospective data entry (here patient information is generally entered after their discharge) and to provide details for each care episode. Likewise, the information containing diagnosis data, outcomes, and processing can be classified as clinical.

The Electronic Health Record and Patient Health Record: EHR or PHR is an essential type of health information system. As the standards vary among different countries, the EHR and PHR also vary within various countries. Therefore a common and open standard is necessary. The development of open EHR is meant to fulfill this need.

Open EHR consists of a set of open specifications within the architecture of EHR. However, it cannot be regarded as a software application only. It is designed to fulfill the purpose of enabling semantic interoperability of the health information system within and between the different EHR systems. All the EHR systems are in the non-proprietary format to avoid the vendor lock-in of information.

All the knowledge concepts of health care are stored in a structured manner called the archetypes and kept outside the software. Recording of all the common clinical activities is supported by the types of archetypes. Some of the main building blocks of archetypes consist of instructions, evaluations, observations, and actions. Information built as per these building blocks gets stored in the EHR in a larger composition structure having its own archetypes.

Financial and Clinical Health Information Systems: Often another division of health information system is made. This is the financial and clinical health information system, which allows easy access to patient costing and helps in monitoring a patient’s usage of different departments. This is done by tagging the various deliverables (recorded in the clinical system management) with their associated prices. But it must be noted that most costing is done on the basis of estimation as per apportioning the whole costs retrospectively (more frequently as per the previous years' costs). Another important characteristic of these financial systems is that they have the capacity of invoicing as well as following up any non-payment incident. Thus, such a system becomes an integral part of hospitals and clinics for smooth operation.

Decision Support Health Information Systems: Decision support in health information system is an important feature. Decision support itself is a well-acclaimed phrase and is usually related to artificial intelligence. Fundamentally, decision support is the system used to get the computer attempting to perform parts of the processing usually done by the user after converting the data into clinically relevant information. Although the technical capability to develop a decision support system in healthcare is practically possible and is now over a decade old, it is still not adopted to the extent that it is used significantly for professional and organizational reasons. The increased adherence to the PCT or NICE guidelines prompted the healthcare organizations to focus more on professional decision support systems. However, it is more of a procedure adherence system rather than a decision support system that ensures the actions of healthcare professionals and their adherence to the guidelines.

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A decision support system in healthcare usually offers the following three supports:

• It presents the health information in a manner (flagging, sorting, classifying) beneficial to cognitive processing. Therefore, it facilitates the user's decision making. For instance, it can present a list of asthma drugs instead of listing drugs for every condition.
• It gives the results of several data manipulations. The decision support system can mimic parts of the cognitive processing (providing asthma drug lists suitable for 8-year-old asthma patients having no other illness).
• It gives data manipulation results and can make some suitable action by mimicking the cognitive process and the output processing (the system arranges the next suitable appointment after prescribing the drugs).

All health information systems (HIPAA) have direct and indirect benefits to the healthcare organization, giving it a competitive advantage. It offers the opportunity to enhance patient care and increases the profitability of every healthcare organization including hospitals and clinics.