Hospital Information System (HIS) is an important branch of emerging medical informatics recognized by international academic circles. Morris. In 1988, Collen, a famous professor in this field in the United States, defined the hospital information system as the ability to collect, store, process, extract and exchange data of patients' diagnosis and treatment information and administrative information for all hospital departments by using electronic computers and communication equipment, so as to meet the functional needs of all authorized users.

[Edit this paragraph] Meaning

Improve hospital management and support medical teaching and research.

Information processing in Chinese hospitals is still in manual mode, which is labor-intensive and inefficient. Doctors, nurses and managers spend a lot of time on routine work, which leads to "making the best of people"; Patients wait in line for a long time, and there are many tossing and turning processes, which affect the order of the hospital; Retrieving medical records, clinical trials, pathological examinations and many other valuable data is very laborious and even difficult to achieve; The in-depth statistical analysis of these data can not be carried out manually and can not be fully used in medical research; In economic management, there are also phenomena of missing, running and wrong charging; Due to inaccurate information, unclear family background, backlog and waste, hospital material management can not make the best use of it. Developing HIS is an effective way to solve the above problems. The effective operation of HIS system will improve the efficiency and quality of hospital work and promote medical research and teaching; Reduce the labor intensity of routine work, so that they can spare more energy and time to serve patients; Improve management, plug loopholes and ensure the economic interests of patients and hospitals; Create economic benefits for the hospital.

The complete HIS system realizes the whole process tracking and dynamic management of information, thus simplifying the patient's diagnosis and treatment process, optimizing the medical environment, and changing the status quo of long queue, long waiting time and disorder. For example, at present, most hospitals have to go through a series of processes such as registration, waiting for medical records, pricing, charging, taking medicine or treatment. A patient has to queue for at least 3 times, and the process takes at least 1 hour. If HIS is implemented, the intermediate process time spent by each patient on diagnosis and treatment will be greatly reduced. Assuming that the outpatient volume of a hospital is 2000 person/day, and the annual outpatient volume is 250 days, and each person spends less than half an hour, it saves 1000 hours a day and 360,000 hours a year, and its social and indirect economic benefits are obvious. At the same time, the implementation of HIS has also strengthened the internal management of the hospital, reduced the work intensity and time of medical staff, solved the phenomenon of forgery, omission and omission, accelerated the capital turnover and reduced the backlog of drugs, instruments and other materials. It is estimated that if 2000 hospitals in China use HIS, the annual benefit of each hospital in increasing revenue and reducing expenditure, speeding up capital withdrawal and turnover, blocking and reducing material backlog is estimated to be about 200,000 yuan (actually higher than this), then the annual benefit is estimated to be about 4 billion yuan, which is very impressive. But this is often not recognized. Of course, the establishment of HIS mainly lies in its comprehensive benefits to hospital management, medical quality and medical research. Therefore, the input of HIS generally needs basic input, just like the statistical department of any institution, it is a department that spends money, but its importance is recognized and input is also necessary. The benefits of HIS go far beyond the hospital itself, because complete patient medical records are important information resources for medical research, and most of these resources are abandoned in artificial working environment.

[Edit this paragraph] Domestic and international situation and development trend

(a) Developments abroad

Electronic computers have been used in hospitals for more than 30 years. In the early 1960s, the United States began to study his. The famous Massachusetts general hospital

1985 the national hospital data processing survey shows that 100 beds or more, 80% hospitals have realized computerized financial charge management, and 70% hospitals can support patient registration and administrative affairs management. 25% hospitals have a relatively perfect HIS, that is, medical staff in wards can directly use computers to process medical orders and query laboratory test results. 10% of hospitals (2,530) have fully computerized HIS.

The development and application of HIS in Japan began in the early 1970s. Most hospitals in Japan didn't start their work until after the 1980s, but it developed very rapidly, with a considerable scale, and it was a hospital computer system centered on mainframes. Such as IBM/3090 dual-computer system of Beijing University Hospital. At present, the general trend of HIS in Japan is systematization, networking and integration, and it has begun to take a top-down development route. Generally, there is a host computer as the center to support the whole system, and microcomputer and network technology are adopted as far as possible. The investment scale is large, and the "order-based" working mode is being realized, that is, the data is directly input into the computer from the source. By 199 1 year, nearly 10 companies have realized or basically realized this mode. The function of supporting diagnosis and treatment is constantly strengthened, and the system runs 24 hours a day. Many softwares are jointly developed by hospitals and computer companies, some large companies have also developed some general hospital information management software packages, and some hospitals have developed them themselves. For example, Beijing University of Science and Technology has developed a comprehensive HIS, and the development cost (excluding machinery and equipment) is 340 million yen (about130,000 yuan). The daily operating expenses are 5 10/00000 yen (about 20 million RMB) a year.

The development of HIS in Europe is a little later than that in the United States, and most of it started in the mid-1970s and 1980s. The characteristic of European HIS is the realization of some regional information systems. For example, RedSystem in Denmark manages 76 hospitals and clinics. The eighth medical and health center in France has realized an integrated information system-Grenobleintegratedhis, which can manage three large hospitals and three medical schools. With the development of primary health care, the computer network of hospitals in European countries and regions will be realized. At present, the SHINE project in the European Community

(2) Domestic situation

Computers entered the medical industry in China in the late 1970s. At that time, IBM's M340 minicomputer was the mainstay, and only a few large subordinate general hospitals and teaching hospitals owned it, such as Peking Union Medical College Hospital, Beijing Cancer Hospital and 30 1 Hospital. Mainly used for scientific research and teaching, not for his management. In the early 1980s, with the appearance of Apple PC and the popularity of BASIC language, some hospitals began to develop some small management software, such as payroll software. In the mid-1980s, with the appearance and localization of XT286 and the appearance of DBASEIII and UNIX network operating systems, some hospitals began to establish small local area networks and develop small network management systems based on department management, such as hospitalization management and pharmacy management. In 1990s, NOVELL network, FOXBASE and FOXFRO databases became more and more popular, making it possible to realize a complete hospital network management system, so some hospitals with computer technology began to develop hospital management systems suitable for their own hospitals. Some computer companies, such as Dalian Huiyuan Electronic System Engineering Co., Ltd. (cooperating with 30 1 Hospital), IBM, Microsoft and Inspur, are not suitable for developing HIS. But these systems all have the following problems:

1. The software level is low. Generally, it can only do some primary transaction processing. Some software development stops after a period of time for the following reasons:

(1) The hospital is short of computer professionals and weak in technical force, especially high-level system analysts and interdisciplinary talents.

(2) There are many projects and scattered forces.

(3) Hospital funds are limited, so it is difficult to establish an ideal supporting environment for software and hardware.

2. Repeated development. According to a provincial survey, in the past few years, among the 262 projects developed in total, the salary system project is 465,438+0, the medical statistics project is 265,438+0, and the personnel project is 265,438+0 ... The repetition rate is over 70%.

(1) There are some differences in the management methods of the company, so the software cannot be used universally.

(2) There is no uniform standard for software, so it is difficult to popularize it.

(3) No high-level hospital management software package can be widely popularized in China.

[Edit this paragraph] A complete hospital information system

(1) Hospital management information system and clinical information system

The main goal of hospital management information system (HMIS) is to support the hospital's administrative management and transaction processing, reduce the labor intensity of transaction processing personnel, assist the hospital management, assist the top leaders in making decisions, improve the hospital's work efficiency, and enable the hospital to obtain better social and economic benefits with less investment, such as financial system, personnel system, hospitalization management system, and drug inventory management system.

The main goal of clinical information system (CIS) is to support the clinical activities of hospital medical staff, collect and process patients' clinical medical information, enrich and accumulate clinical medical knowledge, provide clinical consultation, assist diagnosis and treatment, assist clinical decision-making, improve the work efficiency of medical staff, and provide more, faster and better services for patients. Such as medical order processing system, patient bedside system, doctor workstation system, laboratory system, drug consultation system, etc. Belongs to the category of CIS.

Undoubtedly, a complete hospital information system (IHIS) should include hospital management information system and clinical medical information system.

Hospital management information system needs less resources, and its disk capacity, number of workstations, network transmission capacity and display quality are far below the requirements of CIS.

The computer technology supporting the hospital management information system is simple and clear. Because the hospital management information system mainly deals with text and digital data, it is less involved in the complex requirements of dynamic transmission of sound, image and multimedia data, so it is much easier to implement.

Clinical information systems generally have stricter requirements than management information systems in real-time data processing, response speed, security and confidentiality.

Considering the input and output, most hospital decision makers believe that compared with CIS, HMIS can make hospitals get systematic returns more directly, obviously and quickly. In other words, with less investment, you can get more benefits.

Of course, HMIS and CIS are not completely separated, and HMIS often involves some patients' clinical information, especially the patient main index and the first page of medical records collected by HMIS, which are often the basis of CIS's patient-centered clinical medical information. Once CIS is established, it will often make the work of HMIS more accurate and efficient.

(B) Three levels of computer information processing

The information processing of a complete hospital information system can be divided into three different levels: the process of data collection; The process of centralized data processing, processing and analysis and the process of decision consultation and decision support. Generally speaking, the data collection process is related to the transaction processing activities of grass-roots departments; The process of centralized data processing and analysis is related to the tasks of middle-level departments; The decision-making and support process is related to senior leaders.

1. supports online transaction processing.

Information flow is usually accompanied by a variety of window business processes, which may be the administrative business of people, money and materials in the hospital, or the medical affairs related to outpatient, emergency and inpatient. For example, the personnel department should handle the adjustment and change of hospital staff wages; The General Affairs Section is responsible for the supply, procurement and distribution of materials, office supplies and low-value consumables of all departments in the hospital; Doctors in wards should always prescribe medical advice to hospitalized patients; Nurses should constantly sort out doctor's orders or various prescriptions, drug receiving orders, injection orders, treatment orders and laboratory inspection orders, and implement and record the implementation process; Outpatient pharmacy pharmacists should draw the price for prescriptions, fill medicines for patients and distribute medicines; Outpatient charge office should complete the pricing and charging business, affix the payment mark on all kinds of prescriptions, tests and checklists, and pay patients' bills (reimbursement forms). In all these complicated and trivial business activities, a lot of information is produced. The HIS we developed should support these daily and massive foreground transactions. Transaction-level computer systems (such as outpatient charging system, ward doctor's advice processing system, etc.). ) should undertake dual tasks at the same time.

For window business personnel, these systems are tools to help them complete their daily heavy window business. With the help of computer system, their messy work becomes orderly, and they are freed from the difficulty of memorizing a lot of information (specifications and prices of drugs, names and codes of diseases, etc.). ). Ensure that they comply with certain norms and reduce their burden of collecting, counting, reporting and transmitting this information. Therefore, this kind of software should conform to the working order and habits of these transaction-level staff as much as possible, with complete functions, simple operation, quick response, friendly interface, easy to learn and use. Users should feel that the system is dedicated to helping them complete the window business. Any other functions of the system (functions other than supporting window business processing) should be as backstage and hidden as possible, so as not to be perceived by the end users, and not to increase or as little as possible the burden of window business processing personnel.

For the whole hospital information system, the window transaction processing of computer system is also a complete HIS data acquisition port. They are the tentacles and receptors that HIS extends to the birthplace of information. For example, the system handling ADT business will inevitably provide real-time information for the inpatient department, and it is also the main source of information for the dynamic statistics of inpatients. Outpatient charging system not only completes the process of patient payment, but also collects the corresponding outpatient income and workload information of various outpatient departments and auxiliary departments that provide medical services for outpatient service. All these data are the original data used by the information system for statistics, analysis and other data processing from the upper level to the highest level. From the point of view of data collection, HIS requires the information collected by the window business system to be complete, accurate, timely and safe.

2. Support the summary and analysis of department-level information.

Middle-level departments of hospitals shoulder heavy management tasks, such as the medical department is responsible for the planning, organization and implementation of medical work in the whole hospital, the supervision and control of medical trends, and the inspection and management of medical quality; The personnel department is responsible for the establishment and adjustment of the hospital, attendance assessment, and evaluation of various professional and technical positions at all levels; The nursing department is responsible for the organization and implementation of hospital nursing work, the management of hospital nursing quality and the management of nursing staff. With the increasingly scientific management, middle-level departments will rely more and more on the basic data they collect from the grassroots to summarize, count and analyze, so as to evaluate the work of grassroots departments and individuals they manage, make plans, supervise implementation, make reports and make decisions.

Computerized information systems should support data collection, synthesis, summary, analysis, reporting and storage of intermediate departments. Department-level information systems should be able to automatically collect data from grass-roots departments on a regular basis, process the data as needed, and generate classified statistical reports and reports that can support the management of middle departments. For example, the statistics room should be able to collect the ADT data of inpatients, the charging data of patients in the charging office, and the clinical data of diagnosis and operation of inpatients in the medical record room, and regularly generate dynamic reports of inpatients, bed use reports and single disease analysis reports. The medical department should collect relevant information from different departments such as inpatient department, statistics room, ward and operating room, and make various reports on medical trends and medical quality control.

Department-level information system is characterized by:

Usually has nothing to do with window transaction work.

There are few real-time data entry tasks.

Regularly process the collected information.

The algorithm of machining is usually fixed.

The purpose is to meet the needs of business management of undergraduate course room or to submit reports regularly.

3. Support the demand of hospital senior leaders for management information.

The top leadership of the hospital must be fully supported by the computer information system in order to realize the scientific management of the whole hospital. The data processed and analyzed by the middle-level department should not only produce statements and reports to be submitted to the senior leaders to directly assist the decision-making of the senior leaders of the hospital, but also directly transmit the processed data to the senior leaders through the computer information system. The top module of HIS: the comprehensive query and decision module of medical financial information receives and reorganizes these data, and combines the information of all functional departments of the hospital, including clinical, administrative, medical and financial information, along two main lines-medical and financial, to provide some very convenient and flexible retrieval and query means to meet the changing needs of senior leaders of the hospital for information. The characteristics of this layer of information system are:

It has nothing to do with any specific transaction, that is, there is no data entry except receiving subordinate data and making various queries and statistical requests.

Its main function is to provide flexible retrieval, query, statistics and analysis capabilities.

The statements and reports generated by the system change with the demand, and the contents are irregular and irregular.

This system is usually associated with some specialized models and algorithms related to hospital management, such as financial management, economic accounting, quality control and dynamic analysis. For example, the supervision and evaluation of medical quality, the supervision and evaluation of hospital financial execution, the supervision and evaluation of medical workload burden of various departments and so on.

The system emphasizes the forms of generating reports, such as graphs and charts. Be flexible and easy to understand.

[Edit this paragraph] function

Broadly speaking, hospital management information system is the concrete application of management system in hospital environment. Therefore, it must have the same characteristics as other MIS systems:

They are all computerized systems with database as the core and network as the technical support environment.

They are information systems with business as the main line, with the main purpose of improving work quality and efficiency and assisting decision-making. They can improve the comprehensive management level, reflect the overall situation of enterprises, enhance their competitiveness, and obtain more and better social and economic benefits.

In the system, several subsystems are divided according to certain principles (a layer of subsystems can also be added on them), and there are interfaces between subsystems, which can effectively exchange information and truly share information resources.

It deals with both structured data and semi-structured or unstructured data. Some data and structures are influenced by human intervention and social factors, namely static and dynamic.

The development is difficult, the technology is complex and the cycle is long.

It has a sound management, supervision and operation guarantee system, as well as corresponding rules and regulations and system safety measures. Hospital information system is the most complex enterprise information system in the world at present. This is determined by the goal, task and nature of the hospital itself. Like all other MIS systems, it should not only track and manage the management information generated by people flow, capital flow and logistics to improve the operation efficiency of the whole hospital, but also support the whole medical, teaching and scientific research activities centered on patient medical information records. The complexity of the system is as follows:

In many cases, it needs extremely fast response speed and online transaction processing ability. When an emergency patient is admitted to hospital for emergency treatment, it is obviously very important to obtain his past medical history and medical records quickly, timely and accurately. When hundreds of patients and their families are crowded in the outpatient hall during the peak hours every day, anxiously waiting in line for registration, waiting for medical treatment, pricing, payment and medicine collection, the system's requirements for OLTP can be said to be no less than any bank window business system and air ticket reservation and sales system.

Complexity of medical information. Patient information is expressed in various data types, which requires not only words and data, but also graphics, charts and images.

It requires high security and confidentiality of information. Patient's medical record is a legally binding document, which will play an important role not only in medical dispute cases, but also in many other legal procedures. There are strict confidentiality requirements for personnel, finances and even medical information of patients.

The amount of data is large. Any patient's medical record is an illustrated book of growth, and it is common for large general hospitals to have millions of patients' medical records.

Medical information processing lacks standards. This is another problem that complicates the development of hospital information system. At present, there are few standards and norms for medical information expression, hospital management mode and information system mode in medical and health circles. In the process of developing information system, computer professionals should spend a lot of energy to deal with information standardization in unfamiliar fields, and even participate in formulating some hospital management models and algorithms. The standardization of medical knowledge expression, that is, how to translate medical knowledge into a form suitable for computers, is a worldwide problem. However, the realization of real electronic patient medical record needs to be solved.

The uncertainty of the overall goal, system, organization, management method and information flow mode of the hospital increases the difficulty of analyzing, designing and realizing HIS. As we all know, China is in the period of great reform and opening up, and the nature, system, organization, system, management concept, methods and means of hospitals are changing, which greatly increases the difficulty of designing HIS.

High-level information sharing needs. Doctors' demand for medical knowledge (such as the usage and dosage of a new drug, contraindications, literature description, conclusions of special cases, etc.). ) and the patient's medical records (whether hospitalized patients or patients who died a few years ago) may occur in all his medical, teaching and scientific research activities, and may occur anywhere. A summary of a hospitalized patient's hospitalization record (the first page of medical records) may also be needed by all relevant clinical departments, medical technology departments and administrative departments (from the doorman to the dean) of the hospital. Therefore, the design of information sharing, the speed and security of information transmission and the reliability of the network must also be guaranteed by HIS.

Psychological and behavioral disorders of medical and administrative personnel. The success of hospital information system depends on the participation of hospital medical staff and managers. The psychological and behavioral obstacles of medical staff and managers to computer application often lead to the failure of a system. In China, due to the general educational background, the popularity of computers and the difficulty of inputting Chinese characters, end users have a more general and strong resistance to using computers. This requires the system designer to pay more attention to man-machine friendly design, better interface, more convenient help information, simpler operation method, easier learning and faster Chinese character information input. This of course increases the overhead and complexity of the system.

Therefore, in view of the uniqueness of hospital environment, the realization of hospital information system should have its special functional requirements:

It should be supported by a large-scale and efficient database management system.

Strong ability to support online transaction processing (OLTP).

A typical 7-day /24-hour uninterrupted system absolutely needs security and reliability.

Easy to learn and easy to use friendly man-machine interface.

Cutability and expansibility can meet the development planning requirements of different hospitals.

Openness and portability, adapting to different software and hardware platforms

Modular structure, scalability

[Edit this paragraph] Architecture

At present, there are only three architectures for HIS to choose, namely, host and terminal time-sharing system, microcomputer network plus file server system and client/server system.

Host-terminal time-sharing system is the basic choice for the development of general hospital information systems in the United States, Western Europe and Japan from 1970s to the end of 1980s. Many successful and famous HIS are developed based on this architecture. This is the host-based model of traditional centralized information management. Although such a system can meet the needs of HIS in terms of the amount of data it can handle, its operating efficiency, the support for a complete relational database and the overall availability of data, it has been criticized more and more theoretically in recent years and strongly impacted by the wave of layoffs in practice. It is generally believed that such a centralized system has too much one-time investment, and the application system is tied to the manufacturer's software and hardware products too much, which loses the openness, flexibility and expansibility of the system. Clumsy software development tools affect the development speed of application software, and API and GUI technologies that can't be compared with PC affect the quality and success rate of application software development. More and more information system managers believe that their centralized HIS based on mainframe will not last long. It's a pity that the centralized system established by many large hospitals in Japan in the 1980' s was abandoned, but it didn't work well and became a heavy burden. Therefore, although the centralized HIS had its past glory, we should not and will not follow the old road of western countries more than ten or twenty years ago when designing the hospital information system in China in the mid-1990s.

Computer network plus file server system can be said to be the mainstream choice of hospital information system architecture in China. The application of computer in China Hospital has gone through the stage of single microcomputer and single task, and multi-microcomputer and multi-task have entered the stage of file server of microcomputer network, which should be acknowledged as a great progress. Microcomputer network supports distributed processing and directly inherits all the advantages of PC system. Users can make full use of their own CPU, share expensive external devices, large-capacity storage devices, laser printers and plotters, and also realize data sharing among multiple users. In fact, some small and medium-sized hospitals have successfully partially implemented HMIS based on this architecture. But such a system may be able to undertake the department-level information management tasks of large hospitals (such as finance department, personnel department or patient admission management, etc.). ), but such a structure is inherently insufficient, which will make it difficult to undertake the task of establishing a complete information system for the whole hospital. This is because: