MEDICAL INFORMATION SYSTEM

A health information system (HIS) is the intersection of between healthcare’s business

process, and information systems to deliver better healthcare services. The nature of healthcare

industry, which is highly influenced by economic, social, politic, and technological factors, has

changed over time.

Nowadays, the widespread use of Information and Communication Technologies (ICT)

has permeated almost all aspects of life including the healthcare sector. HIS was introduced to

fully utilize especially the Internet in providing better healthcare. Health information systems are

frequently refers to the interaction between people, process and technology to support operations,

management in delivering essential information in order to improve the quality of healthcare

services. Haux (2006) describes systems that process data and provides information and

knowledge in healthcare environments as health information systems. Some of terminologies

related to HIS are as follows; Health Informatics, is the field that concerns itself with the

cognitive, information processing, and communication tasks of medical practice, education, and

research including the information science and technology that supports those tasks. Health

informatics tools include computers as well as clinical guidelines, formal medical terminologies,

and information and communication systems. In other words, it emphasis is on

clinical and biomedical applications with added possibility of the integrating clinical components

either among themselves or to more administrative-type health information systems (Conrick,

2006).

Another important terminology in HIS is Electronic Medical Records (EMR), it resides at the

centre of any health information systems. EMR is a medical record in a digital format, whereas
electronic health record (EHR) refers to an individual patient’s medical record in a digital

format. HER systems coordinate the storage and retrieval of individual records with the aid of

computers, which are usually accessed on a computer, often through a computer network.

The use of ICT in healthcare is not new. The Deployment of ICT in healthcare

environment has helped healthcare professionals to improve the efficiency and effectiveness of

healthcare services.

Healthcare information systems that can record and locate important information quickly have

become a standard practice in many healthcare organizations. While, Haux (2006) summarized

the milestone of development for HIS were considered as important: (1) the shift from paper-

based to computer-based processing and storage, as well as the increase of data in health care

settings; (2) the shift from institution centered departmental and, later, hospital information

systems towards regional and global HIS; (3) the inclusion of patients and health consumers as

HIS users, besides health care professionals and administrator.

FUTURE TRENDS

Today, every healthcare organization depends on ICT in every level of activities. Nowadays, the

healthcare relies on process application and information streamline to create value for every facet

of its delivery. The vision of a paperless hospital is delineated as the embodiment of the future

health information systems with the hope is that brings an improvement. Promise of to be more

reliable effective and efficient.

BACKGROUND OF THE DEVELOPMENT OF HEALTH INFORMATION

SYSTEMS
 Medical informatics as a discipline is still young, in particular when compared with other

medical disciplines However approaches to the data processing in medicine and health care have

over 50 years of history. The historical analysis shows major milestones of the development of

global medical informatics and

HIS:

1959, Robert Ledley and Lee B. Lusted published a widely read paper on diagnostic decision-

making appeared in Science, in which the authors expressed hope that by using computers, and

that many human errors could therefore be avoided.

1965 – one of the first clinically-oriented health care Information Systems Technicon Medical

Information System was developed as a collaborative project between Lockheed and El Camino

Hospital in California.

1967 – Health Evaluation through Logical Processing (HELP) was the first hospital

information system to integrate clinical data accumulation and clinical decision support.

1967 – International Medical Informatics Association (IMIA) was established. It has close ties

with the World Health Organization (WHO) as a Non Government Organization, and with the

International Federation of Health Information Management (IFHIMA).

1968 – Computer stored Ambulatory Record (COSTAR), an electronic medical record, was

developed by the Laboratory of Computer Science at Massachusetts General Hospital between

for Harvard Community Health Plan by Octo Barnett and Jerome Grossman.

1960s – first hospital information systems were first introduced. The staff used them primarily

for managing billing and hospital inventory. Major work on: signal analysis, laboratory
applications, modeling and simulation of some biological processes, databases; first attempts on

decision support (diagnosis).

1973 - in the Netherlands at the Free University in Amsterdam the department of Medical

Informatics started under the chairmanship of Jan van Bemmel.

1974 - the department of Medical Cybernetics and Informatics was established in the Soviet

Union, headed by S.A. Gasparyan.

1976 - The Problem-Oriented Medica Information System, or PROMIS, was designed for

maintaining health care records at the University of Vermont by Jan Schultz and Dr. Lawrence

Weed, M.D.

1980 - Edward H. Shortliffe founded one of the earliest formal degree programs in biomedical

informatics at Stanford University, emphasizing a rigorous and experimentalist approach

1986 - European Society for Artificial Intelligence in Medicine (AIME) was established.

1970s - 1980s - a shift from a paper-based to computer-based records system; founding most

national and international organizations, conferences; attempts to systematize major areas of

medical informatics; first specialized schools and courses; principles of clinical and hospital

information systems, security and medical data protection; advanced decision support systems –

expert systems.

1990s–2000s - medical Informatics consolidates nits position as an independent discipline and

is mandatory in most medical schools; hospital information systems are implemented in some

hospitals, mainly for management; first e-health and telemedicine research; notable progress in

data bases, medical imaging; more visible importance and complexity of electronic health record

(HER), including confidentiality, data protection, standards etc.

business; hidden gaps and difficulties in real implementation: integration and interoperability,

modest rate of user acceptance, quality assessment. Clear contour of sub disciplines:

bioinformatics, neuro informatics etc.

SPECIAL ASPECTS OF THE DEVELOPMENT OF HEALTH

INFORMATION SYSTEMS

HIS is a set of software, hardware, and data for automation of health care processes in

medical institutions health and recreation resorts. HIS carries out the following tasks:

- Maintaining of common information space, intended for immediate access to data;

- Improvement of the quality of medical records;

- Control of health care quality and reduction of medical errors;

- Increasing transparency of a medical institution;

- Constant analysis of economic aspects of health care.

OPPORTUNITIES AND CHALLENGES OF HEALTH INFORMATION

SYSTEMS

Some of the opportunities of health information system include the following;

- Cost savings due to reducing of paper work and errors in billing;

- Cost savings on medication due to instant access to comparison of drugs consumed);

- Cost savings on laboratory studies (due to access to comparison of total annual costs of

laboratories);

- Standardization of hospital administration;

- Access to a more complete, accurate and structured documentation of clinical data;

- Automatic sorting of data;

- Direct access to instant updates, including remote access to a patient's medical history;

Some of the challenges of health information system include the following;

The development of HIS is a complex socio technical process, characterized by a high level of

uncertainty.

-Different needs of practical health care representatives (regional authorities, chief physicians,

doctors, nurses etc.).

-State medical institutions which purchase devices and equipment have to adhere to very

serious limitations.

-Long-term implementation of HIS in the context of constantly changing healthcare conditions

and obligations of staff.

THE ELECTRONIC MEDICAL RECORD (EMR)

The electronic medical record (EMR) is the legal patient record that is created in digital format in

hospitals and ambulatory environments. EMRs may include a variety of personal and clinical

information.

HISTORY OF ELECTRONIC MEDICAL RECORD (EMR)

The idea of computerizing patients’ medical records has been around for years, but only

in the past decade has it become widely adopted. Prior to the electronic medical record (EMR), a

patient’s medical records consisted of handwritten notes, typed reports, and test results stored in
a paper file system. Today paper medical records are used in fewer healthcare facilities. The

transition to electronic health records is well underway.

INSTITUTE OF MEDICINE (IOM)

Beginning in 1991, the IOM (a division of the National Academies of Sciences,

Engineering, and Medicine) sponsored studies and created reports that led the way toward the

concepts we have in place today for electronic health records. Originally, the IOM called them

computer-based patient records. 1 During their evolution, EHRs have had many other names,

including electronic medical records, computerized medical records, longitudinal patient records,

and electronic charts. All of these names referred to something intended to replace the paper

chart. In 2003, the IOM chose the name electronic health records, or EHR, because “health”

means “a state of well-being,” and the goal of computerizing medical records is to improve the

delivery of safe, quality care focused on patients’ health.

The IOM report put forth a set of eight core functions that an EHR should be capable of

performing. The eight core functions are as follows:

1. Health information and data This function provides a defined data set that includes such

items as medical and nursing diagnoses, a medication list, allergies, demographics,

clinical narratives, and laboratory test results.

2. Result management Computerized results can be accessed more easily (than paper

reports) by the provider at the time and place they are needed.

3. Order management Computerized provider order entry (CPOE) systems can improve

workflow processes by eliminating lost orders and ambiguities caused by illegible

handwriting, generating related orders automatically, monitoring for duplicate orders, and

reducing the time required to fill orders.

of drugs, diagnosis and management, and detection of adverse events and disease

outbreaks.

5. Electronic communication and connectivity Electronic communication among care

partners can enhance patient safety and quality of care, especially for patients who have

multiple providers in multiple settings that must coordinate care plans.

Patient support Computer-based patient education has been found to be successful in

improving control of chronic illnesses, such as diabetes, in primary care. Examples of home

monitoring by patients using electronic devices include self testing by patients with asthma

(spirometry), glucose monitors for patients with diabetes, and Holter monitors for patients

with heart conditions. Data from monitoring devices can be merged into the HER.

6. Administrative processes and reporting Electronic scheduling systems increase the

efficiency of healthcare organizations and provide better, timelier service to patients

7. Reporting and population health Public- and private-sector reporting requirements at the

federal, state, and local levels for patient safety and quality, as well as for public health,

are more easily met with computerized data because it eliminates the labor-intensive and

time-consuming abstraction of data from paper records and the errors that often occur in a

manual process.

HOW THE ELECTRONIC MEDICAL RECORD WORKS?

How does the computerized system work? The system sends clinical information to the

health-care provider’s EMR inbox with each patient visit carefully documented. It can take up to

6 months to train personnel how to use the system efficiently. However, once the health-care
providers are fully trained, the system allows for a complete examination of the patient’s clinical

information

in a relatively short time. There are a number of organizational concerns when an EMR is

utilized. For example, computer server crashes, security breaches, and off-site data storage can

complicate the use of these systems.

POTENTIAL BENFITS OF THE ELECTRONIC MEDICAL RECORD

(EMR)

Some of the potential benefits that can be realized by using the EMR may include;

The use of an EMR helps to reduce medical errors by utilizing computerized prescription entry,

predicting drug interactions and displaying a warning for the health-care provider, assisting

clinicians in reconciling patient medications, and most important, maintaining a detailed and

legible medical record.

Patients can be seen sequentially by different providers with up-to-date information

immediately available to all providers. This was often difficult when paper charts were being

utilized. In addition, the EMR gives clinicians immediate access to patient medical information,

as well as the ability to enter and store orders for prescriptions, tests, and other services in a

computer based system with orders and clinical notes easily stored.

The system allows the patient to access their own medical information easily and from home.

Moreover, EMRs include scheduling systems that can greatly improve hospital and clinic

efficiency and provide more timely service for patients.

CHALENGES OF USING EMR

Benefits include legible orders, the volume of transcription material is reduced, and orders are

rapidly routed. One large challenge involves getting a large medical staff trained in the use of the

EMR. This is particularly a problem with older physicians who may not be very “computer

savvy.”

The high cost of these systems is another challenge for hospitals and practices. It is often

difficult to measure a financial benefit given the high cost of these systems. An 8-year analysis

of cost–benefit at this institution found that the net present value of the system was positive at

$3617 (US dollars) with a benefit to cost ratio of 1.23.

THE ELECTRONIC MEDICAL RECORD AND MEDICAL ERROR

It is widely believed that EMRs will reduce physician error and increase patient safety by

eliminating errors resulting from illegible handwriting. Medical documentation in the EHR is

clear and legible and thus reduces confusion. The EMRs alert system ensures that proper dosage

and drug utilization are administered to patients. Park et al. noted that the EMR had the potential

to improve patient adherence to prescribed drug therapy.

POTENTIAL PROBLEMS WITH THE ELECTRONIC MEDICAL RECORD

Similar to all new technologies, there are some potential problems with the EMR. Hackers can

easily gain access to security of their health information. Nevertheless, the overall response was

quite positive. . In addition, as noted above, patients are often concerned about the confidentiality

of their personal health information.

1. Jacob JA. Patient access to physician notes is gaining momentum. JAMA 2016;315:2510-1

2. Park LG, Howie-Esquivel J, Dracup K. Electronic measurement of medication adherence.

West J Nurs Res 2015;37:28-49.

3. Morris F. Collen, 2015. Chapter The History of Medical Informatics in the United States

Part of the series Health Informatics p. 123-206

4. M. Ngafeeson, 2014. Chapter. Healthcare Information Systems: Opportunities and

Challenges (IGI Global, Hershey)

5. Choi JS, Lee WB, Rhee PL. Cost-benefit analysis of electronic medical record system at a

tertiary care hospital. Healthc Inform Res 2013;19:205-14.

6. Reinhold Haux, 2010. International Journal of Medical Informatics 79, p. 599–610

7. Haux Reinhold, 2006, Health information systems – past, present, future, International

Journal of Medical Informatics (2006) 75, 268—281.

8. Conrick, M. (2006). Health informatics: Transforming healthcare with technology. Thomson

Social Science Press.

9. Goldschmidt, P.G. (2005). HIT and MIS: Implications of health information technology and

medical information systems. Communications of the ACM, 48(10), 69-74.

10. Pyper C, Amery J, Watson M, Crook C. Access to electronic health records in primary care –

A survey of patients’ views. Med Sci Monit 2004;10:SR17-22.

11. https://www.pearsonhighered.com/content/dam/region-na/us/higher-ed/en/custom-

product/gartee-electronic-health-records-3e/pdf/gartee3e-ch1.pdf
 FEDERAL UNIVERSITY OF LAFIA
COURSE CODE: CSC222

COURSE TITLE: MANAGEMENT INFORMATION SYSTEM

GROUP COURSE WORK

S/N NAMES MATRIC TOPIC