HELP: A Dynamic Hospital Information System

342 Pages·1991·6.445 MB·English

by  Gilad J. Kuperman M.D., Reed M. Gardner Ph.D, T. Allan Pryor (auth.)

Computers and Medicine
Helmuth F. Orthner, Editor
Computers and Medicine
Information Systems for Patient Care
Bruce I. Blum (Editor)
Computer-Assisted Medical Decision Making, Volume 1
James A. Reggia and Stanley Tuhrim (Editors)
Computer-Assisted Medical Decision Making, Volume 2
James A. Reggia and Stanley Tuhrim (Editors)
Expert Critiquing Systems
Perry L. Miller
Use and Impact of Computers in Clinical Medicine
James G. Anderson and Stephen J. Jay (Editors)
Selected Topics in Medical Artificial Intelligence
Perry L. Miller (Editor)
Implementing Health Care Information Systems
Helmuth F. Orthner and Bruce I. Blum (Editors)
Nursing and Computers: An Anthology
Virginia K. Saba, Karen A. Rieder, and
Dorothy B. Pocklington (Editors)
A Clinical Information System for Oncology
John P. Enterline, Raymond E. Lenhard, Jr., and
Bruce I. Blum (Editors)
HELP: A Dynamic Hospital Information System
Gilad J. Kuperman, Reed M. Gardner, and
T. Allan Pryor
Gilad J. Kuperman Reed M. Gardner
T. Allan Pryor
HELP: A Dynamic Hospital
Information System
With 110 Illustrations
Springer-Verlag
New York Berlin Heidelberg London Paris
Tokyo Hong Kong Barcelona Budapest
Gilad J. Kupennan, M.D. Reed M. Gardner, PH.D,
National Library of Medicine Fellow in Professor, Depanment of Medical
Medical Informatics Informatics
LOS HospitallUniversity of Utah University of Utah;
Salt Lake City, UT 84143, USA Co-chainnan, Department of Medical
Informatics LOS Hospital;
T. Allan Pryor
Salt Lake City, UT 84143, USA
Professor, Department of Medical
Informatics
University of Utah;
Co-chairman, Depanment of Medical
Informatics LOS Hospital;
Salt Lake City, UT 84143, USA
Series Editor:
Helmuth F. Orthner
Professor of Computer Medicine
The George Washington University Medical Center
Washington, DC 20037, USA
Library ofConvus Cataloain,_in_Publi~ation Data
Kuperman, Gilad J.
HELP: A d)'JIami~ hospital information system/ Gilad J. Kuperman,
Reed M. Qardner, T. Allan Pryor.
p. cm. - (Computeroand medicine)
In~ludes biblio&raphical referen~es.
ISBN.I3: 978·1-4612_7785·9 e·ISBN-13: 978-1-4612·3071).(1
DOl: 10.1007/978-1-4612-3070·0
I. HELP (Information retrieval system) 2. Medical care-Data
proccssirtJ;. 3. Hospital care-Data procnsin,. 4. Hospitals
Administration-Data procnsin,. I. Gardner, Reed M. II. Pryor,
T. Allan (Thomu Allan) III. Title. IV. Series: Computers and
medicine (New York, N.Y.)
jDNLM' I. Decision Making, Computers-As!.isted. 2. Hospital
Information Systems. 3. Medical Record.. WX 26.S K96h]
R85g.K86 1991
610' .185-dclO
DNlM/DlC
for Library of Congress 9().10349
Printed on acid-free paper.
@ 1991 Sp.ing...--Verlag New York Inc.
All riJ;hts reserved. This work may not be translated or copied in whole or in pan without the wriuen
permiHion of the publisher (Sprinaer-Verlag New York, Inc., 175 Fifth Avenue, New York, NY 10010,
USA), except for brief e>o:cerpts in connection with reviews or scholarly analysis. UK in connection with
any form of infonnation stor. .. and retrieval, electronic, adaptation, computer software, or by similar or
dissimilar methodology no .. known or hereafter developed is forbidden.
The use of ,eneral descriptive namu, tralk names, trademarks. etc., in this publiution, even if the fonner
are not especially identified, is not 10 be taken aJ a sian that such names, as understood by the Trade Marks
and Merchandise Act, may accordingly be used freely by anyone.
While the advi« and informalion in t!lis book is believed to be true and accurate al the date of ,oinll (0
press, neither the authors nor the editors nor the publisher ~an accept any legal responsibility for any errors
or ominions that may be made. The publisher makes no warranty, e>o:press or implied, with respect to the
material contained herein.
T)'pcset by B)'1hc"ay Typesettin. Services, Norwich, NY,
Printed and bound by Ed. .a rds Brothers, Inc., Ann Arbor, ME.
Softcover reprint of the hardcover 1st edition 1991
987654321
ISBN_I3: 978_1-4612.7785·9 Springer-Verlq; New York Berlin Heidelber,
To my parents and brother and close friends
in Utah, California, and Hawaii.
-G.l.K.
To Dr. Homer R. Warner, our mentor and department chairman.
-R.M.G.
-T.A.P.
Note to the Reader
HELp™ is a trademark of 3M Corporation. Because the HELP system
originated and continues to be developed at LDS Hospital, all of the appli
cations described in this book may not yet be commercially available. Infor
mation about commercially available versions of the HELP system may be
obtained from 3M Health Information Systems in Murray, Utah, USA.
vii
Series Preface
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.
Information technology is advancing at an accelerated pace. Instead of
waiting five years for a new generation of computer hardware, we are now
confronted with new computing hardware every 18 months. Similarly, the
forthcoming changes in the telecommunications industry will be revolution
ary. Within the next five years, certainly within the next decade, new digital
communications technologies, such as the integrated services digital net
work (ISDN), will not only change the architecture of information systems
but also the way we work and manage health care institutions.
The software industry is trying to provide tools and productive develop
ment environments for the design, implementation, and maintenance of
information systems. Still, the development of information systems in med-
ix
x Series Preface
icine is to a large extent an art and the tools we use are often self-made and
crude. One area that needs desperate attention is the interaction of health
care providers with the computer. The user interface needs improvement
and the emerging graphical user interfaces may form the basis for such
improvements. Eventually, multi-media information must be incorporated
into the workstations used by the health care providers.
To develop an effective clinical system requires an understanding of
what is to be done, and how to do it, and an understanding on how to
integrate information systems into an operational health care environment.
Such knowledge is rarely found in anyone individual; all systems described
in this monograph series are the work of teams. The core of these teams is
usually small but dedicated to working together over periods sometimes
spanning decades. Clinical information systems are dynamic systems; the
functionality is constantly changing because of external pressures and ad
ministrative changes in the health care institution. This dynamic functional
ity is often underestimated when systems are acquired from and maintained
by vendors. Good clinical information systems will and should change the
operational mode of providing care which, in turn, affects the functional
requirements of the information systems. This interplay requires that medi
cal information systems are flexible on the one hand and willingness by the
organization to adjust and, most of all, provide end-user education. This
interplay may take some time, perhaps a year. Although medical informa
tion systems should be functionally integrated, these systems must be mod
ular so that upgrades, additions, and deletions of functional modules can
be done incrementally in order to match the pattern of capital resources
and investments available to an institution.
We seem to build medical information systems just as automobiles were
built early in this century (191Os), Le., in an ad-hoc manner disregarding
standards even if they exist. Technical standards addressing computer and
communications technologies are necessary but not sufficient. We need
to develop conventions, agreements, standards, and perhaps even a few
regulations that address the core of medicine and the principal use of medi
cal information in computer and communication systems. I presume, if the
building industry would not have developed its conventions, agreements,
standards, and regulations, most of us would be living in tents or wooden
shacks since we could not afford a house built with only custom parts.
Standardization allows the mass production of low cost parts, which can
be used to build more complex structures. What are those parts in medical
information systems? We need to identify them, classify them, describe
them, publish specifications, and perhaps even standardize them.
Clinical research, health services research, and medical education will
benefit greatly when controlled vocabularies are used more widely in the
practice of medicine. For practical reasons, the medical profession has
developed numerous classifications, nomenclatures, dictionary codes and
thesaurus terms (e.g., lCD, CPT, DSM-III, SNOMED, COSTAR diction-
Series Preface xi
ary codes, BAlK thesaurus terms, MESH, etc.}. The collection of these
terms represents a considerable amount of clinical activities, the large por
tion of the health care business, and a focus for clinical research. These
terms and codes form a sort of 'glue' linking the practice of medicine with
the business of medicine or the practice of medicine and the literature of
medicine. Since information systems are more efficient and effective in
retrieving information when controlled vocabularies are used in large data
bases, the attempt to unify and/or build bridges between these coding sys
tems is a great example of unifying the field of medicine with informatics
tools as is done by the unified medical language system (UMLS) projects
performed and coordinated by the National Library of Medicine, NIH, in
Bethesda, Maryland.
The purpose of this series is to capture the experience of medical infor
matics teams who have successfully implemented medical information sys
tems. We hope the individual books in this series will contribute to the
evolution of medical informatics towards a recognized professional disci
pline. We are at the threshold where there is not only the need but also the
momentum and interest in the health care and computer science communi
ties to identify and recognize Medical Informatics.
Washington, DC HELMUTH F. ORTHNER
Preface
The HELP computerized hospital information system has been under de
velopment here at LDS Hospital in Salt Lake City for more than 20 years,
first under the direction of Dr. Homer R. Warner and more recently under
the direction of Dr. T. Allan Pryor, Dr. Reed M. Gardner, and others.
Throughout its history, the system has served as a vehicle for the study of
the use of computers in medical care. Research areas have included signal
processing, automated data collection, medical decision making (including
reasoning under uncertainty), and human-machine interfaces. As the title
of this work implies, the system has been constantly under development,
with new capabilities continually being added and outdated functions being
either enhanced or discontinued.
Adherence to an integrated computerized patient database has remained
a constant feature of the system. The integrated database ensures that all
applications will have access to all patient data stored in the system regard
less of what application initially stored the data. For example, a program
designed to review medication orders for potential adverse reactions has
access to information from the clinical laboratory even though the labora
tory information was stored by a completely different program (and even
by a different computer).
LDS Hospital, the integrated computerized patient database, and com
puterized medical decision-making techniques have combined to provide
the HELP system designers with an environment in which to develop many
diverse and innovative clinical computing applications. New computerized
applications have been incorporated into clinical practice and have been
tested and evaluated. Although the number of clinical applications has
grown, accurate descriptions of these applications have been scattered
throughout many journals and conference proceedings. Interested parties
could only be introduced to the system on an individual basis and describing
the entire system became overwhelming. Even some people working closely
with certain aspects of the HELP system would be unaware of details of
other parts of the system. There was obviously a need for a description of
the system for all those expressing interest in it.
xiii