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INTRODUCTION 7 Physician Order Entry(POE) Decision-Support Technique (DST) Medication System Order Entry systems allow professionals to order tests, additional investigations, drugs and other ‘services’ electronically. Results are also reported back electronically, and often, intermediate steps can be monitored. POE systems explicitly attempt at having the doctor perform these tasks, which should, amongst others, reduce errors due to illegible handwriting and miscommunication. Since the orders that are given and the results that are received should also be part and parcel of the EPR, a POE is often designed so as to be able to fulfil the role of an EPR. A decision support technique attempts to improve decisions taken by health care professionals through providing the professional with salient advice, reminders or alarms at the proper time. Also, systems that actively guide professionals through separate steps in a decision or action process are sometimes called DSTs. DSTs can be built into EPRs and POEs. The latter combination especially affords the production of protocollized order sets, automatically generated advice and reminders when an order is given (or is forgotten), and so forth. A medication system is like a POE system focused especially on handling and monitoring a patient’s medication. (Indeed, POE systems usually encompass medication systems.) It allows professionals to overview and prescribe medication, and it may monitor and check omissions, dosing mistakes, interactions and so forth. Further, it may be integrated with an automated dispensing system and/or electronic drug administration support. An example of such an addition could be robot-produced, patientspecific, pre-wrapped medication strips and a bar scanner with handheld device through which administering the drugs may become a safeguarded procedure as well. Hospital Information System (HIS) Most hospitals still have an HIS: an integrated application supporting a broad range of functions in a hospital. Constructed around a common patient database, laboratory systems, radiology systems, and discharge letter production and storage can all be built in. In addition,
8 INTRODUCTION General Practitioner Information System (GPIS) Data Warehouse the operation of the pharmacy, the kitchen, and the EPR may all be built in as well. Because of their integrated nature, such systems were once highly efficient, but are now seen as outdated. Currently, ‘hospital information systems’ would ideally exist of a wide array of applications, from different vendors, specialized in only one of these functions. In this way, ‘best of breed’ systems (the best EPR, the best PIS, the best Data Warehousing system, etc.) could be linked together because they all adhere to socalled ‘open’ standards defining their interfaces. Although the term resembles the HIS, the GPIS is usually a stand-alone application, made for an individual GP (or a small group practice). It is basically an EPR with added administration and medication functions, and functions facilitating riskgroup management (such as the execution of a preventive influenza vaccination campaign, the monitoring and handling of diabetes patients, and so forth). Many different versions exist (see Chapter 2). A data warehouse is a database that draws information seen as relevant for management information (or research, or teaching purposes and so forth) out of the root databases of the (modules of the) PCIS. In this way, even large queries of the database do not affect overall PCIS performance. More importantly, most HISs are poorly equipped for generating any management information, so that a ‘data warehouse’ is often the only technically feasible way to get to this information with some ease. REFERENCES Collen, M.E. (1995) A History of Medical Informatics in the United States, 1950 to 1990. American Medical Informatics Association. Coiera, E. (2003) Guide to Health Informatics. London: Arnold. Committee on Quality of Health Care in America (2001) Crossing the Quality Chasm: A New Health System for the 21st Century. Washington: National Academy Press. van Bemmel, J. and M.Musen (1997) Handbook of Medical Informatics. Berlin: Springer Verlag.
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Page 6 and 7: Contents List of illustrations vii
Page 8 and 9: Illustrations FIGURES 3.1 Medicatio
Page 10 and 11: Contributors Marc Berg is a physici
Page 12 and 13: Series preface In almost all Wester
Page 14 and 15: Acknowledgements I would like to th
Page 16 and 17: Chapter 1 Introduction In all Weste
Page 18 and 19: INTRODUCTION 3 touch upon the deplo
Page 20 and 21: INTRODUCTION 5 can draw upon to mai
Page 24 and 25: Part I Starting points Understandin
Page 26 and 27: WAITING FOR GODOT 11 KEY TERMS ■
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Page 30 and 31: WAITING FOR GODOT 15 facts to show
Page 32 and 33: WAITING FOR GODOT 17 (Lewinski-Corw
Page 34 and 35: WAITING FOR GODOT 19 In most cases,
Page 36 and 37: WAITING FOR GODOT 21 (Anonymous 191
Page 38 and 39: WAITING FOR GODOT 23 Because of the
Page 40 and 41: WAITING FOR GODOT 25 they simply sa
Page 42 and 43: WAITING FOR GODOT 27 expected. Stil
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Page 50 and 51: WAITING FOR GODOT 35 CONCLUSION: TH
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Page 54 and 55: WAITING FOR GODOT 39 Anonymous (191
Page 56 and 57: WAITING FOR GODOT 41 Berg, M. (1997
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Page 60 and 61: HEALTH CARE WORK AND INFORMATION SY
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HEALTH CARE WORK AND INFORMATION SY
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THE CONTEXTUAL NATURE OF INFORMATIO
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Chapter 5 Meeting the challenge Int
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STARTING POINTS 81 ‘gender, race,
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STARTING POINTS 83 Now, imagine an
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STARTING POINTS 85 organization,
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STARTING POINTS 87 Figure 5.2 Incre
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STARTING POINTS 89 already overflow
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STARTING POINTS 91 responsibilities
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STARTING POINTS 93 answer the quest
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STARTING POINTS 95 Kohn, L.T., J.M.
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Chapter 6 Designing interactions En
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DESIGNING INTERACTIONS 99 the way t
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DESIGNING INTERACTIONS 101 1 Identi
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DESIGNING INTERACTIONS 103 the deve
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DESIGNING INTERACTIONS 105 communic
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DESIGNING INTERACTIONS 107 Figure 6
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DESIGNING INTERACTIONS 109 ■ Figu
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DESIGNING INTERACTIONS 111 measurem
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DESIGNING INTERACTIONS 117 Covell D
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Part II Information strategy, imple
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INFORMATION STRATEGY: AN INTRODUCTI
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Chapter 8 Developing the informatio
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STRATEGY, IMPLEMENTATION AND EVALUA
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Guidelines for information system d
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Chapter 9 Implementing information
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IMPLEMENTING INFORMATION SYSTEMS 16
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Chapter 10 Project management of in
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Index accumulation 53-4, 61, 73-4,
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INDEX 223 contingent and emergent c
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INDEX 225 satisfaction 176 patient
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INDEX 227 support 164 technology de
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