A doctor's prescription for hospital info system; Children's builds integrated system atop standards, best of breed packaged products - Dr David M. Margulies is VP of Information Systems at Children's Hospital, Boston

Software Magazine, April, 1990 by John Desmond

A DOCTOR'S PRESCRIPTION FOR HOSPITAL INFO SYSTEM

Over 39,937 E-mail messages ago, the journey of physician-computer scientist Dr. David M. Margulies began at Children's Hospital, Boston.

The vice president of the information systems department at Children's, Margulies was hired in 1986 to bring the hospital into the modern age of computing. Now well into a three-year plan that concludes at year-end, Margulies' experience demonstrates that advances in hardware and especially software technology in the mid- to late-1980s now make possible a state-of-the-art integrated hospital information system (HIS) based on off-the-shelf products and software standards.

The lesson for commercial MIS and data processing is that today's technology can be used to create an integrated information system featuring a central "virtual" database that balances the needs of departments with those of the overall organization, and the ability to exploit technical advances such as the networking of text, voice and image objects. Another lesson is that client/server database architecture can provide some clear benefits.

A primary advance that makes Children's HIS possible is a distributed, relational database with a standard query language. Children's chose Oracle from Oracle Corp., Belmont, Calif., in late 1986.

"The decision to license Oracle proceeded from the emphasis on network-based application distribution, platform independence and the belief that Oracle was going to be a fiscally sound and growing concern," said Margulies, who is a graduate of the Harvard Medical School, Boston.

In Children's HIS, Oracle is a central "virtual database," accessible from any department requiring its services. The virtual database either points to or replicates major subsets of departmental data needed to create cross-departmental views. Its data elements are those that need to be shared by diverse systems. For example, a physician in an intensive care unit can use a departmental Macintosh or VAXstation to call up a patient's X-ray. Oracle contains the pointers to help make the connection possible.

The decision to create this virtual database was made because no supplier then or now offers an off-the-shelf HIS solution that could satisfy all hospital users. Also, Margulies views custom software developed in-house as too expensive to build and maintain. Each department at Children's is free to acquire the best available software, as long as the supplier is willing to write the interfaces to connect to the virtual database.

Until Margulies arrived, Children's information system was typical of a hospital at the time: IBM mainframe with 200+ terminal users, used primarily to run batch-oriented financial applications.

But the hospital's clinicians were awakening to the power of computers, spurred by their counterparts at Beth Israel and Brigham and Women's hospitals, Boston, Duke University, Durham, N.C., and the Latter Day Saints Hospital, Salt Lake City, all of which had developed innovative computing solutions.

Further incentive for a revolution in MIS followed from changes in federal government hospital reimbursement formulas, which began to reward operating efficiency.

This delay in the automation of hospitals may have been a blessing in disguise. "Health care was really the abandoned stepchild of computing for many years. The market was not really a business until the advent of DRGs [Diagnosis Related Groupings, of U.S. Department of Health and Human Services], which forced health care to become a business," Margulies said. "But by awakening late, health care may have an advantage."

HIS GOALS

Children's senior management concluded that information systems needed to be a high priority for investment, and that the organization needed a chief information officer. A team was assigned to design an HIS architecture. The goals were to: emphasize a balancing of department and institution needs, automate patient records in stages, meet standards of information systems excellence, and use industry standards and commercial tools where possible.

The specific needs of financial, clinical, research and academic computing at Children's, a teaching hospital affiliated with the Harvard Medical School, meant that the HIS had to be multivendor. "There is no vendor with an HIS whose functionality is adequate across clinical departments," said Margulies.

Children's chose a clustered, processor-based system using distributed, heterogeneous database techniques and an Ethernet local area network. Phase one consisted of installing the wiring scheme and network management tools; phase two was to acquire departmental applications; and phase three has been to tie the departments together into the virtual database.

The hardware environment currently features a Digital Equipment Corp. VAXcluster (two VAX 8800s, an 8700, and on order, a VAX 6000-440). The hospital also owns an IBM mainframe (3090-150E running VM with Oracle under MVS, an "Oracle server"), VMS workstations, PCs Macintoshes and other connected processors. The total computer power approximates 100 Mips, excluding PCs. The IBM mainframe has four connections to the VAXcluster: Flexlink; a DEC SNA gateway product which does terminal emulation; an Interlink product which makes the MVS mainframe a Decnet node; and Oracle SQL/Connect from VMS to MVS. The network has 3,500 users and 1,400 devices in 26 departments.