Integrated HIS for community hospitals: small hospitals can get the same "big bang" efficiencies and functionality as large hospitals with an integrated hospital information system - Hospital Information Systems

Health Management Technology, Dec, 2001 by David Dye

Disseminating information to outside agencies and managing reimbursement issues, while simultaneously meeting compliance regulations, can be problematic for any hospital. Community hospitals face additional challenges because of fewer employees and limited budgets.

Community hospitals lack the infrastructure and multiple levels of management that usually exist in larger facilities. This requires community hospital executives to take a hands-on approach to hospital operations, giving them a deeper understanding of the specific issues facing the various departments.

One of the biggest issues community hospitals are confronted with is finding a cost-effective hospital information system (HIS) that pro vides up-to-date technology while meeting both state and federal regulatory requirements. A community hospital's HIS capability today typically consists of a legacy financial and patient accounting system. In many cases, a hospital may have added disparate information systems for the pharmacy, laboratory and radiology departments.

This approach requires numerous hardware resources for each component and adds to the responsibility of the hospital's IT staff. As existing systems become outdated due to advances in technology or changes in regulatory mandates, more and more community hospitals look to consolidate their HIS into a more integrated system that is flexible enough to include all areas of patient care or that can be added to as other systems must be upgraded or replaced.

Power of Integration

A truly integrated system does not require the hospital to allocate IT staff to create and continually update interfaces between independent systems. It also eliminates the need for multiple servers and operating systems that can strain IT resources. This level of integration not only puts less demand on a hospital's IT staff, it can directly benefit the level, quality and cost of patient care.

For example, how many individual interfaces are necessary to provide all the information from separate systems needed by caregivers, such as vital signs, graphical I/Os, transcription documents, billing information, abnormal lab results, problem lists from nursing and electronic Medication Administration Records (MAR)? The answer is--a lot.

An integrated HIS allows laboratory results to be reported and then accessed immediately by all caregivers, whether they are nurses working in the hospital or physicians looking at current data provided by a secure Web-based application from their offices across town. Further integration allows for an electronic MAR to be established between nursing and the hospital pharmacy.

An integrated system also proves beneficial in meeting HIPAA regulations. Audit trails of individuals accessing protected patient information will be required, if requested by the patient, beginning in 2003. If the information is stored on several different systems in several different software applications, how many interfaces are required to obtain this information? Once again, the answer is--a lot.

With increased federal and state regulations, security is another issue community hospitals must address. It is important to determine whether disparate applications can handle added security features in the same or similar manner and if all will allow for biometric identification and a single sign-on for all applications.

If complete federal and state regulatory compliance isn't part of the system or if the IT staff doesn't have the resources available to ensure systems meet all regulations, a lack of compliance can lead to penalties and fines that could cost a hospital tens of thousands of dollars. Therefore, it is important to have access to system updates and to know how much it will cost to meet all new regulations.

The Transition Process

No one could deny that an integrated HIS provides all of these features, but how does a community hospital transition from the systems currently in use? It depends on the hospital's individual needs and resources.

The clearest assessment of a hospital's needs includes information about what systems a hospital currently uses, budgetary constraints, and what type of conversion and implementation plan the hospital chooses to utilize. Hospitals should avoid building short-term interfaces, which tend to be costly and time consuming. At the same time, a hospital cannot discontinue information sharing between current departments and systems. It is crucial, when selecting an integrated HIS, that each component is flexible enough to work with existing systems while handling additional installations of other system components as the hospital works to become fully integrated.

Typically, when implementing an integrated HIS, there are three major installation grouping phases: financial and patient accounting, order entry/ancillary applications, and nursing point-of-care.

If the hospital has budget constraints and does not currently use any clinical software applications, starting with only the financial and patient accounting system may be the best option. If the budget allows, many hospitals opt to implement both financial and patient accounting and order entry/ancillary applications.