Hospital information system
A hospital information system ( HIS ) is the class of the entirety of all information processing systems in information technology for recording, processing and forwarding medical and administrative data in the hospital .
HIS includes server functions, workstation functions and mobile functions for data provision. In a broader sense, the HIS also include conventional methods of paper-based documentation and voice communication. In general, the term is now restricted to the computer-based components of the HIS.
In this context, one speaks of “HIS manufacturers” and “HIS market”, whereby “HIS”, in deviation from the generally accepted definition, does not mean an instance of an information system in a particular hospital, but a software product that is essential Covers functional areas of a typical hospital information system.
The term HIS is also used to denote all less specific server functions of a hospital network and this from special systems such as the radiology information system (RIS), the laboratory information system (LIS or LIMS), the intensive care unit information system (IIS) and so on. In the case of adoptions from Anglo-American parlance, KIS is also referred to as HIS (Hospital Information System).
The fundamental goal of KIS is to meet the requirements of the SGB V . After that, it is not enough to simply write or type information on a piece of paper. The HIS should improve communication between employees and organize and control the entire process in a hospital. This includes the administration of patient master data and case data.
The functions of hospital information systems are to secure, change and present information and data. This has the potential advantage that every authorized employee of a hospital has access to data relevant to him in his assigned user role .
The focus of the functions lies in the administrative area, especially the collection of illness data (e.g. anamnesis ), documentation and planning of medical and nursing activities, i.e. care planning and care documentation as well as the medical reports and doctor's letters . The prescription of examinations or treatments (order entry) by the doctor as well as the administration and documentation of the examination results must be fulfilled.
HIS functions are more and more often provided as part of mHealth applications on mobile devices.
Planning, control and billing
The planning and management of medical services (eg, via clinical treatment paths , Engl. Clinical pathways ) is facilitated with modern KIS. The hospital information system supports the creation of documents (doctor's letters, surgical reports ), etc., whereby parts of these documents can often be suggested on the basis of the previously collected data. Summarizing evaluations of statutory and internal reporting are essential.
For the purposes of billing for health insurances , health insurances and self-payers, case data are classified according to the ICD code , medical services provided according to the OPS code (formerly: ICPM code ) or DRG case flat rates Diagnosis Related Groups and for the calculation of the invoice data (including Material and working time) are used for cost unit accounting.
Production data acquisition
Well-known HIS perform production data acquisition in various levels of detail. An exact record of the individual benefits is usually only given for benefits in kind. No support is usually provided for staff services, which make up the lion's share of the remaining costs.
Last but not least, logistical functions such as the support of material orders (warehouse and special material) on the ward (if necessary with approval workflow), the documentation of the flow of consumables in the hospital (e.g. in the operating theater or in the X-ray department), including the assignment of Material costs supported for the specific case.
Achieved maturity levels
Depending on your opinion, fully integrated systems are not to be expected, have long been installable, not desirable or not possible. In fact, the steady increase in complex new functions means a steady expansion of the existing scope of definitions, so that a complete solution will always only correspond to the definitions of the previous version.
A hospital information system is highly complex. There are no binding norms and standards. Formats and protocols are only standardized for data exchange or the corresponding standards are in preparation, see e.g. B. HL7 , DICOM .
One of the tasks for the HIS providers is to continuously change statutory accounting rules, quality assurance measures, etc., which force manufacturers and operators to maintain permanent maintenance. This maintenance ties up capacities that could otherwise be used for further developments.
Depending on the strategy of the provider, the integration strategy (everything from a single source) or the communication strategy (variety of interfaces) of the own HIS software is propagated. Smaller manufacturers tend to offer special or niche solutions that larger manufacturers cannot adapt to the specific requirements of a house so quickly.
Data availability and data protection
HIS are always viewed with skepticism from the point of view of data protection , as large amounts of very sensitive personal data that need to be protected are managed in the systems. The skeptics have no recommendation on how to solve the balancing act between data protection and data availability without HIS.
First of all, in medical emergencies, access to all data (e.g. allergies, previous medication) must be possible for every hospital doctor who is first on site. This also applies if it is not the primary treating doctor. This is currently mostly made possible by "emergency access authorizations", the access of which is strictly logged.
Statically defined, restrictive access rights may limit the usefulness of HIS in its necessary work, whereby too generous rights allocation could reveal too much sensitive information. A dynamically restricted access rights management defined in the current context has not yet been implemented in any introduced system. Special solutions for role-compliant access control are offered separately and offer the same interfaces for all operated systems.
There is a constant strong consolidation in the German market for hospital software. As a result, new providers keep appearing who, with solutions for smaller facilities or with highly specialized solutions, take over lower market shares of the established providers or open up new functional areas. The lifespan of such smaller new providers is usually linked to the gradient of the initial market success. However, the established large manufacturers are not immune to break-ins either.
Modern concepts of mobile information applications are increasingly finding their way into the equipment concepts of clinics. So far, large university clinics and private clinic groups have played a pioneering role. The interest in mobile solutions is also growing steadily among smaller and medium-sized institutions. In contrast, the willingness to invest in the full expansion of such concepts in publicly owned clinics is completely inadequate because of the cameralistic budgeting.
Paradigm of coordination in self-control
So far, it has not been possible to transfer the actual, routine coordination practice into the system concepts of the hospital software through the self-control of competent employees with a flat hierarchy .
The patient-centered part of a HIS ( Clinical Workplace System , KAS) is playing an increasing role in the coordination of the services of a hospital, while the previously leading administrative part of the HIS is pushed back to background processes and, with its remote functionality, is integrated into the overall process of service provision and billing.
As a rule, the innovative components for direct use by patients are not widely used and the medical components are poorly networked at the patient's bedside.
For the successful introduction and operation of HIS software, the modeling and optimization of clinical processes is of central importance. There are no generally binding templates for this. So far, traditional concepts of hierarchical control have dominated. The solution components for flow-oriented coordination ( workflow management ) are usually poorly developed or unsuitable for daily routine.
The basis for the design of the clinical information systems, for the selection of software products and for the management and operation of information systems must be a critical analysis of the requirements with a distinction between essential functions and special requirements .
- Patient data management system (PDMS)
- Drug Information System (AMIS)
- Picture Archiving and Communication System (PACS)
- DICOM (Digital Imaging and Communications in Medicine; open standard for the exchange of medical images)
- HL7 (Health Level 7)
- Integrating the Healthcare Enterprise (IHE)
- GMDS (German Society for Medical Informatics, Biometry and Epidemiology)
- HealthTech Wire Dossier: mHealth - 2012
- Requirements for information processing in hospitals ( memento of the original from January 5, 2007 in the Internet Archive ) Info: The archive link has been inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
- Electronic Health Record System Functional Model and Standard
- AMIS drug information system ( Memento of the original dated July 10, 2011 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. of DIMDI
- Peter Haas: Medical Information Systems and Electronic Medical Records , Springer Verlag, Berlin 2004, ISBN 3-540-20425-3 .
- Hans-Ulrich Prokosch: KAS, KIS, EKA, EPA, EGA, E-Health - a plea against the Babylonian confusion of terms in medical informatics . In: Computer science, biometrics and epidemiology in medicine and biology. 32, No. 4, 2001, pp. 371-382 (PDF; 196 kB).
- Hans-Ulrich Prokosch, Joachim Dudeck (Eds.): Hospital information systems: design and development characteristics; impact and future architecture , Elsevier, Amsterdam 1995, ISBN 978-0-444-82129-4 .
- Roland Trill: Information technology in hospitals. Strategies, choice, commitment. Hermann, Luchterhand 2002, ISBN 978-3-472-04765-0 .
- Behrendt, König, Krystek Future- oriented change in hospital management. Springer-Verlag Berlin Heidelberg 2009, ISBN 978-3-642-00934-1 .
Literature on historical development
- G. Fuchs, G. Wagner (ed.): Hospital information systems - what has been strived for and what has been achieved. Schattauer, Stuttgart 1972.
- CO Köhler: Integrated hospital information system - target definition and framework model. Hain, Meisenheim am Glan 1973.
- G. Wersig: The hospital information system (HIS). Publishing house documentation, Munich ao 1971.
Literature on data protection when using HIS systems
- 81st Conference of the Federal and State Data Protection Commissioners: Resolution: Data protection-compliant design and use of hospital information systems online
- Sub-working group on hospital information systems of the working groups on health and social issues as well as technical and organizational data protection issues of the conference of data protection officers of the federal and state governments: Orientation aid for hospital information systems. ( OH-KIS ) PDF
- Claus O. Köhler: History of Medical Informatics in Germany from the Beginnings to 1980 . (on the history of medical informatics; PDF file; 1.23 MB)