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Hospital Information Systems: "IT follows process"
Henning Schneider; © UKE
The implementation of IT in hospitals simplifies many processes and makes them less expensive. In order to implement a hospital information system successfully, however, experts have to overcome a lot of obstacles: medical processes must be adapted to IT and medical personnel has to be trained adequately.
COMPAMED.de wanted to know how state of the art IT adapts to increasingly complex tasks in clinical practice and is able to run paper-free. Therefore, we spoke to IT manager Henning Schneider, who is working at the University Hospital Hamburg-Eppendorf (UKE) in Germany.
COMPAMED.de: For about four years you have overseen the introduction of a new hospital information system. What challenges did you face during the introduction?
Henning Schneider: During the first few months it was essential to adapt the medical processes to IT. Our credo was: IT follows process. That is why we wrote a process manual that documents the complete procedures in the hospital and adapted the software to the processes. Every medical area had a key user with whom we defined these processes. Even after the IT systems were introduced, we had to continue to adjust the processes. Ultimately our goal was make all processes completely paper-free. Three assistant medical directors, two senior attendants and one senior medical technical assistant formed a team that reviewed all steps with the Hospital Board of Directors. It was essential that the Board of Directors was one hundred percent committed to this project, because a top-down approach was required. We all agreed that a hospital with two speeds is not conducive and that we would have to change to digital medical records fairly quickly.
COMPAMED.de: Which technologies did you introduce for the processing of medical procedures at the UKE?
Schneider: To be able to establish all technical procedures well, we provided staff members with the complete system as an e-learning tool. Behind the technology is a system made up of individual modules. In the emergency room we use a so-called tracking board as a central module. Another module is the physician’s statement. From the medical findings of the patient and individual forms, the phrases are filtered at the push of a button to describe the course of disease. The physician only has to edit the report and add a treatment recommendation. The physician’s report is completed the moment the patient leaves the hospital.
COMPAMED.de: Apart from the amount of paper that is being saved by IT, what impact does this development have on day-to-day hospital operations?
Schneider: IT makes hospital processes more transparent, especially because physicians and nurses work in a uniform system. It proves to be easier for a caregiver and a physician to switch to another medical area. This does not just improve the quality of treatment, but also the interdisciplinary work. We measured that today patient medical records are accessed about 50,000 times each day. This hit rate would have been utopian with paper records. Consequently the times when you had to look for patient records is now over.
COMPAMED.de: Nevertheless, digitization of patient records in the scope of electronic health records makes people suspicious. How do you ensure patient data security?
Schneider: Physicians are also worried about this issue, especially since security holes could pertain to patient/physician confidentiality. That is why we commissioned the German Federal Office for Information Security to review the information security and as the very first hospital ever were granted the IT Baseline Protection Certificate for patient records. Although we already have very secure networks , within the scope of this certification we even documented the detailed communication connections between the individual servers at port level and cut them back to a minimum level. This way, even separate networks at UKE were once more additionally regulated.
The IT-experts try to curtail the data of medical records by storing as much structured data as possible;
COMPAMED.de: Who receives access authorization?
Schneider: Only those disciplines that are involved in the treatment have access to the patient data. In addition, each access is documented in the system. If a physician wants to consult another physician, he/she has to log this activity in the intelligent authorization concept. The patient can afterwards also find out who accessed his/her medical records. This was impossible with paper records.
COMPAMED.de: Large amounts of data is accrued for thousands of patients each year. How do you contain this data growth and at the same time manage more and more data volumes?
Schneider: That will be the big challenge for the next few years. We try to curtail the data of medical records by storing as much structured data as possible. Large amounts of data accrue for image data, which we try to reduce with intelligent compression and by working closely with physicians. The point is to sensitize and to develop a new understanding for where data needs to be stored and for which processes it can be deleted again. One alternative to handle increasing data volumes could be the Cloud – assuming it is secure and cost-efficient. Moreover, a Cloud poses very different requirements on data security and this is something that still needs to be worked on.
COMPAMED.de: How does the optimal, digital information chain between physicians, hospitals, diagnostic centers and other treatment institutions take place to treat patients as best as possible?
Schneider: The task is for each unit to work independently digitally, because information exchange can only take place digitally. As soon as there is media discontinuity, for instance if you collaborate with another hospital that still works with paper records, the cooperation oftentimes does not work. The biggest challenge is in the area of private medical practitioners. This is where a heterogeneous system landscape exists. A standardized, secure network for data exchange would therefore be preferable.
COMPAMED.de: Medical assistants also increasingly would like to use their own computers or another mobile device. “Bring Your Own Device“ (BYOD) is the trend and keyword. What kinds of developments do you expect in this area?
Schneider: Mobile computing presents two challenges: on the one hand, technical access has to be simple and secure. It is going to be important to clear these concepts for standard communication such as e-mail with the Federal Agency for Information Security (BSI). On the other hand, software manufacturers should produce a user interface that works with mobile devices. You also have to ask the basic question at which area and for which steps during the process you would like to use mobile devices. Due to the smaller user interfaces and different operating systems, the functions have to be well adapted to the situation where the device will be used. So far during tests we have gotten the devices back after a few days from disappointed users, because operation and data entry are still too complicated.
The interview was conducted by Diana Posth and translated by Elena O’Meara.