Information Systems In Health Care

Information systems are the key to solving the problem of accessing clinical data for biosurveillance. The past 3 decades have seen the emergence of electronic systems to manage almost every aspect of medical practice, including scheduling, ordering of tests, recording of clinical observations, and intensive care unit operations. Some of these systems are widely deployed; others have far less market penetration. To realize the potential of clinical data for biosurveillance, the market penetration of those systems that collect needed clinical data must increase (especially into outpatient settings) and the systems must be "biosurveillance enabled,'' which means they must provide certain functions and do so in a standard way.

Because of the enormous potential of data collected by the healthcare system for biosurveillance, we devote this lengthy section to a description of the information systems that the healthcare system presently uses to collect and store data. We have written this section with the needs of designers and developers of biosurveillance systems in mind. Therefore, in addition to describing the systems, we highlight data relevant to biosurveillance and any technical or administrative barriers to obtaining the data. We offer our opinion about which systems provide the most immediate and the most long-term potential for biosurveillance. We suggest questions that a biosurveillance organization should ask a healthcare system or hospital when discussing options for creating electronic data exchange. For readers that have limited time, our conclusion will be that HL7 (Health Level 7)-message routers offer the most immediate potential for bidirectional data exchange between biosurveillance organizations and the healthcare system, and that point-of-care (POC) systems represent the future of biosurveillance. Table 6.2 summarizes the systems that we will discuss—the data they contain, their market penetration, and their potential role in biosurveillance. As a general rule, the larger the hospital or healthcare organization, the more likely it will have each system.

6.1 HL7-Message Routers

Figure 6.1 illustrates the information-system architecture of a typical hospital (or multihospital system). At the heart of the architecture is an HL7-message router.3 An HL7-message router is a communication hub that transmits information between information systems, both within the healthcare system and outside of it. HL7-message routers are commercial off-the-shelf products supplied by many vendors (there is an open-source HL7-message router called Jengine available at http://www.jengine.org/ and an HL7 listener, which can receive messages from a hospital HL7-message router, at openrods.sourceforge.net). They are also called integration engines. Healthcare systems often employ HL7 interface engineers and network engineers to configure and maintain these systems around the clock.

The importance of the HL7-message router for biosurveillance is twofold. First, many clinical information systems send data to the HL7-message router (Figure 6.1). The data include patient chief complaints, dictations, results of laboratory tests, and results of radiological examinations. The information systems send these data to the HL7-message router in real time, and the HL7-message router can forward these data to biosurveillance organizations without delay. If a computer in a biosurveillance organization is temporarily incapable of receiving the data, the HL7-message router will queue the data for up to a week until the computer becomes available. Second, an HL7-message router can support bidirectional, real-time communication between computers in a healthcare system and computers in a biosurveillance organization by using the

3 The term HL7 (Health Level 7) refers to the dominant messaging standard in health-care computing. Briefly, the HL7 standard was developed in the 1980's by a coalition of information system vendors to allow their systems to more readily exchange data. We discuss the HL7 standard in detail in Chapter 32.

TABLE 6.2 Information Systems in Healthcare: Data, Relevant HL7-Message Types, U.S. Market Penetration (Estimated), and Potential Uses of the Data in Biosurveillance

System

U.S. Market Penetration

Data

HL7 Message Type and Event

Hospital/Health Office/Home System Health

LTC Facility

Potential Biosurveillance Use

System

Data

HL7 Message Type and Event

Hospital/Health Office/Home System Health

LTC Facility

Potential Biosurveillance Use

HL7-message

Data from many of the

N/A

High

Large HMOs

If owned

Best current single

router

systems listed below

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