HELP: A Dynamic Hospital Information System

This monograph series is intended to provide medical information scien­ tists, health care administrators, health care providers, and computer sci­ ence professionals with successful examples and experiences of computer applications in health care settings. Through the exposition of these com­ puter applications, we attempt to show what is effective and efficient and hopefully provide some guidance on the acquisition or design of informa­ tion systems so that costly mistakes can be avoided. The health care industry is currently being pushed and pulled from all directions - from the clinical side to increase quality of care, from the busi­ ness side to improve financial stability, from the legal and regulatory sides to provide more detailed documentation, and, in a university environment, to provide more data for research and improved opportunities for educa­ tion. Medical information systems sit in the middle of all these demands. They are not only asked to provide more, better, and more timely informa­ tion but also to interact with and monitor the process of health care itself by providing clinical reminders, warnings about adverse drug interactions, alerts to questionable treatment, alarms for security breaches, mail mes­ sages, workload schedules, etc. Clearly, medical information systems are functionally very rich and demand quick response time and a high level of security. They can be classified as very complex systems and, from a devel­ oper's perspective, as 'risky' systems.

I. Overview of the HELP System.- 1. History of the HELP System.- 1.1 The Cardiovascular Period: 1954 to 1967.- 1.2 Expansion of the Database: 1967 to 1972.- 1.3 Growth of Clinical Applications/Addition of Decision-Making Capability: 1972 to 1990.- 1.4 Conclusion: The HELP System Today.- References 13.- 2. HELP System Hardware.- 2.1 Tandem Computer.- 2.2 Other Computer Systems Connected to the Tandem.- 2.3 Summary.- 3. The Data Dictionary and Data and File Structures.- 3.1 Medical Terminology Representation Scheme.- 3.2 HELP System Data Structures.- 3.3 HELP System File Structures.- 3.4 Database Query Languages.- 3.5 Summary.- 4. HELP System Interfaces.- 4.1 Data Acquisition.- 4.2 Outputs.- 4.3 Conclusions.- References.- 5. Decision Support on the HELP System.- 5.1 Data, Information, and Knowledge.- 5.2 Data Management on the HELP System.- 5.3 Information Processing on the HELP System.- 5.4 Use of Computerized Medical Knowledge on the HELP System.- 5.5 Summary.- References.- 6. Current Usage of the HELP System.- 6.1 Evaluation of the HELP System.- 6.2 User Attitudes.- 6.3 Security.- 6.4 Future Directions of the HELP System.- 6.5 Summary.- II. Administrative Functions on the HELP System.- 7. Admit-Discharge-Transfer Functions.- 7.1 Patient Types and the Master Patient Index.- 7.2 Scheduling and Admitting Programs.- 7.3 Patient Numbers.- 7.4 Transfers and Discharges.- 7.5 Room Trace and Census.- 8. Medical Records Functions.- 8.1 Overview.- 8.2 Medical Records Data Maintained on the HELP System.- 8.3 Manipulation of the Medical Record.- 8.4 Chart Location.- 8.5 Reports and Other Utilities.- Reference.- 9. Computerized Data in Quality Assurance.- 9.1 Overview.- 9.2 Quality Assurance.- 9.3 Blood Ordering Program.- 9.4 Pharmacy.- 9.5 Infectious Disease Monitoring.- 9.6 Pathology.- 9.7 Nutritional Support.- 9.8 Respiratory Therapy.- 9.9 Computerized Laboratory Alerting System.- 9.10 Other Functions.- 9.11 Continuous Quality Improvement.- References.- 10. Surgery Scheduling.- 10.1 Overview.- 10.2 Scheduling.- 10.3 Case Carts.- 10.4 Decision Support.- 10.5 Operating Room Times Program.- 10.6 Data Review.- 10.7 Cost Capture.- References.- 11. Miscellaneous Administrative Functions.- 11.1 Order Communications.- 11.2 Computerized Dietary System.- 11.3 The HELP System in the Emergency Room.- References.- III. Use of the HELP System in the Intensive and Acute Care Units.- 12. The HELP System in the Intensive Care Units.- 12.1 The Intensive Care Units at LDS Hospital.- 12.2 HELP Applications in the Intensive Care Units.- 12.3 Reports.- References.- 13. Nursing Information System.- 13.1 Computerized Nurse Charting.- 13.2 Computerized Nursing Care Plans.- 13.3 History Module.- 13.4 Assessment Module.- 13.5 Planner.- 13.6 Medications.- 13.7 Acuity and Management Functions.- 13.8 Evaluations: Bedside Terminals, Charting, and Care Plans.- 13.9 Computerized Nursing Reports.- References.- 14. Computerized Respiratory Care Charting.- 14.1 Overview.- 14.2 Data Stored.- 14.3 Data Integration.- 14.4 Decision Logic.- 14.5 Reports.- 14.6 Evaluations.- 14.7 Future Directions.- References.- 15. The Pharmacy Application of the HELP System.- 15.1 Overview.- 15.2 Data Flow.- 15.3 Decision Logic and Data Integration.- 15.4 Results of Studies.- 15.5 Nonalert-Related Functions.- 15.6 Future Directions.- References.- 16. The LDS Hospital Laboratory System.- 16.1 Overview.- 16.2 Network Overview.- 16.3 Information Flow Within the System.- 16.4 Interfacing Strategy and Details.- 16.5 Discussion.- 16.6 Future Directions.- 16.7 Reports.- References.- 17. Computerized Laboratory Alerting System.- 17.1 Overview.- 17.2 Background.- 17.3 Design.- 17.4 Data Sources and Reports.- 17.5 Evaluation.- 17.6 Current Status.- References.- 18. Computerized Infectious Disease Monitor.- 18.1 Overview.- 18.2 Data Stored.- 18.3 Decision Logic.- 18.4 Reports.- 18.5 Results of Studies.- References.- 19. Computerized Blood Gas Interpretation and Reporting.- 19.1 Overview.- 19.2 Order Entry.- 19.3 Measurements.- 19.4 Calculations.- 19.5 Data Integration.- 19.6 Decision Logic.- 19.7 Reports.- 19.8 Evaluation.- References.- 20. Medical Information Bus.- 20.1 Overview.- 20.2 Design of the Medical Information Bus.- 20.3 Device Communications Controller.- 20.4 Standards.- 20.5 Current Implementation.- References.- 21. Hemodynamic Monitoring.- 21.1 Overview.- 21.2 Continuous Blood Pressure Monitoring.- 21.3 Cardiac Output Measurements.- 21.4 Reports.- References.- 22. Computerized Total Parenteral Nutrition Ordering and Nutritional Therapy Monitoring.- 22.1 Overview.- 22.2 Computer-Assisted Ordering.- 22.3 Alerts.- 22.4 Nutritional Support Services.- 22.5 Reports.- 22.6 Data Integration.- 22.7 Statistical Analysis.- 23. Computerized Protocols for Ventilator Management.- 23.1 Overview.- 23.2 Motivation for the Protocols.- 23.3 Decision Logic.- 23.4 Performance Evaluation.- References.- 24. Surgery Monitoring on the HELP System.- 24.1 Overview.- 24.2 Complete Surgical Record.- 24.3 Data Retrieval.- 25. Use of APACHE II on the HELP System.- 25.1 Overview.- 25.2 APACHE II.- 25.3 Use of APACHE II on the HELP System.- References.- IV. Other Clinical Applications on the HELP System.- 26. Blood Ordering on the HELP System.- 26.1 Overview.- 26.2 Quality Assurance in Blood Utilization.- 26.3 Blood Ordering.- 26.4 Standing Orders.- 26.5 Data Integration.- 26.6 Evaluation.- 26.7 Conclusion.- References.- 27. Computerized Gathering of Cardiac Catheterization Data.- 27.1 Overview.- 27.2 Cardiac Catheterization.- 27.3 Connection with the Tandem Computer.- 28. Electrocardiograms on the HELP System.- 28.1 Overview.- 28.2 Marquette Universal System for Electrocardiography.- 28.3 Integration with the HELP System.- 28.4 Conclusion.- References.- 29. Use of the HELP System by Radiology.- 29.1 Overview.- 29.2 Order Entry and Billing.- 29.3 Results Reporting.- 29.4 Mammography Management Project.- 29.5 Extraction of Coded Findings from Reports.- 29.6 Future Uses of Decision Logic in Radiology.- 29.7 Conclusion.- References.- 30. Computerized Pulmonary Function Testing.- 30.1 Overview.- 30.2 Data Stored.- 30.3 Integration and Decision Logic.- 30.4 Reports.- References.- 31. Physicians’ Remote Call-In Network.- 31.1 Overview.- 31.2 System Components.- 31.3 Security.- 31.4 Evaluation.- References.- 32. Computerized Urinary Catheter Culture Monitoring.- 32.1 Overview.- 32.2 Goals and Methods of the Program.- 32.3 Reports.- References.- V. Inactive or Experimental HELP System Modules.- 33. Computerized History Taking on the HELP System: Initial Efforts, Goals, Methods, and Evaluations.- 33.1 Overview.- 33.2 Goals.- 33.3 General Considerations.- 33.4 Data Acquisition.- 33.5 Results.- 33.6 Revision of Diagnostic Logic.- 33.7 Discussion.- 33.8 Future Directions.- References.- 34. Computer-Assisted Pregnancy Management.- 34.1 Overview.- 34.2 Data Collection.- 34.3 Frame-Based Medical Knowledge Representation.- 34.4 Reports.- 34.5 Evaluation.- 34.6 Future Directions.- References.- 35. Currently Inactive HELP Programs.- 35.1 Computerized Digoxin Intoxication Alerting.- 35.2 Computerized Arrhythmia Management.- 35.3 Use of Treatment Protocols Within the HELP System.- References.- Appendix A: Acknowledgments.- Appendix B: HELP System Dissertations and Theses.- Appendix C: HELP System Publications.- Appendix D: LDS Hospital Statistics for 1990.