Transcript Intranet Technology in Hospital Information Systems

Intranet Technology in Hospital
Information Systems
James J. Cimino, M.D.
Department of Medical Informatics
Columbia University
Accessing Clinical Information over
the Internet and World Wide Web
James J. Cimino, M.D.
Department of Medical Informatics
Columbia University
Web Access to the EMR at
Columbia-Presbyterian Medical Center
James J. Cimino, M.D.
Department of Medical Informatics
Columbia University
CPMC in 1988 - preTCP/IP
IBM Mainframe
Data
Repository
Data
Monitor
Ancillary Systems
Vocabulary
Server
Results
Review
Clinicians
CPMC in 1991 - TCP/IP
IBM Mainframe
Data
Repository
Data
Monitor
Vocabulary
Server
Results
Review
Intranet
Upload
Engine
Minicomputer
Vocabulary
Server
Ancillary Systems
Minicomputer
Clinical
Application
Vocabulary
Server
Clinicians
CPMC in 1994 - WWW
IBM Mainframe
Data
Repository
Data
Monitor
Intranet
Minicomputer
Internet
Knowledge Resources
Web
Server
Vocabulary
Server
Clinicians
Clinical Database
• Row-oriented relational database (DB2)
• Flexible and extensible
• Clinical data coded with MED
• Multiple time stamps
Data Monitor - Input and Alerts
• Stores all data in repository
• Checks data for triggers
• Executes Medical Logic Modules
• Stores alerts in database
Clinical Database Server - Output
• Dynamic queries (SQL)
• Canned queries
– Time span
– Last "n" results
• Class-based retrievals
("get all positive culture
results")
Medical Entities Dictionary (MED)
• 56,000 medical concepts
• 82,000 synonyms
• Multiple hierarchy (72,000 links)
• Semantic network (43,000 links)
Calcium
Preparations
Calcium
Serum Calcium
Intravascular
Calcium Tests
Plasma Calcium
Abnormalities
of Calcium
Hypercalcemia
Hypocalcemia
MED Server
• Lexical searching
• Concept attributes
• Classes
• Ancestors
Web Server
• Clinical database queries
• Vocabulary server queries
– Class queries
– Translation
• HTML document generation
• Applets
• Web links
CPMC’s Web EMRs
• Elpis - single patient view
• PolyMed - service view
• WebCIS - multiple views
Web EMR Features
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Frame-based interface
Summary reporting
Graphical displays
Multimedia displays
Cross-patient displays
Order entry
Integration of on-line resources
Security and confidentiality
screen shots
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patient list
departmental screen
headers - lab
details - lab
lab summary
lab graph
radiology - detail
dop - detail
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alerts
cardiology - detail
ecg
multi-patient summary
lab order entry
pharmacy list
pharmacy rx
time view
Integration of On-line Resources
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Lab to Medline
Lab to PDR
Lab to disease description (DXplain)
Lab to differential diagnosis (DXplain)
Lab to guideline (cholesterol)
Drug to dietary restriction information
Drug to PDR
X-ray to Medline
X-ray to Web information sources
screen shots of integration
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Lab to disease description (DXplain)
Lab to differential diagnosis (DXplain)
Lab to guideline (cholesterol)
Drug to dietary restriction information
Drug to PDR
X-ray to Medline
X-ray to Web information sources
Security and Confidentiality
• User logon name and password
• Encryption (SSL)
• Logon screen ID (single use)
• Session screen ID (expires)
Current Challenges
• Application development
• Navigation of hypertext
• No control over client machines
• Resource integration
• Hospital mergers
parting shot - carmen sandiego lab