networks in health systems€¦ · – mpi – master patient index – adt – census – patient...
TRANSCRIPT
Networks in health systems
Networks reading
• Shortliffe chapter 10– Integrated delivery networks
Context
• References: – Healthcare information systems: Davidson
(Auerbach Best Practices Series)“The general perception that the use of information technology in healthcare is ten to fifteen years behind that of other industrial sectors such as banking, manufacturing and the airline industry is rapidly changing”
Banking
• Track money– Secure– confidentiality
• Loan and mortgage approval– Intelligent assistance– Automated loan approval
• Credit card fraud management• Medical counterparts
Airline
• Airline tracking• Luggage tracking• Passenger tracking• Price tracking• Customer satisfaction • Medical counterparts
Manufacturing
• Process management– Raw materials– Assembly line
• Inventory control– Just in time
• Sales– What’s selling where
• Medical counterparts
FDDI RingD
FDDI RingA
FDDIH
FDDI"G"
FDDI"F"
NEB PENNTOWER
SILVER FoundersA3440 Spruce
FoundersB3440 Spruce
3440AMarket
3001Market
3600Market
3624Market
3930Chestnut
T3 T3
PennMedRadnor
PaH
T1
3440BMarket
3535Market
NJREMOTE
SITES
PRESBY
FarmJournal
MALONEY
Triad
Phoenixville
LimerickPA
REMOTESITES
PA FRAMERELAY
3440 FRAMERELAY
Functions and components of a HIS
• Financial and resource management– Billing (multiple bills from multiple providers)– Infrastructure support
• Materials management
• Managed care support– Provider profiling– Contract management– Patient triage
Functions and components of a HIS
• Patient management– MPI – master patient index– ADT – census– Patient tracking?
• Departmental management– Radiology, pharmacy etc
Functions and components of a HIS
• Care delivery and clinical documentation– Order entry and results reporting– Clinical pathways
• Clinical decision support– Remind re: allergies– Smart alarms– Diagnostic support
1965-73
• Large central computers (IBM/SMS)• VDT’s• Inhouse data processing, software support• Example
– Technicon medical information system– TDS– Eclipsys
1965-73
• TMIS• Dual IBM mainframes
– One machine for user interaction– One machine for batch billing– Redundancy– Could serve multiple hospitals over dedicated
phone lines
1965-73
• Advantages: – well integrated
• Disadvantages: – Costly to implement and maintain– Not nimble
HIS
• 1970’s
Radiology?
LIS?
ADT
Niche
Billing?
1973-83
• Modular HIS– Several mainframes– Communicate through central machine– Limited networking
• Example– Distributed hospital computer program (DHCP)– Modules
• Registration, ADT, scheduling, lab etc• Written in MUMPS
Modular systems
• Advantages– More responsive to local users– Smaller central machine
• Disadvantages– Difficulties with integration, communication
Latter 1980’s
• Distributed systems– Microcomputers– Gateways between LAN’s
• Development of standards– Communication– Nomenclature
• 1980’s
CISLIS
Radiology ADT
Niche
Billing?office
CIS
Private offices
Doctor’s schedulingoffices
Service locations• 1990’s
Hospital floors
IDN
• now
Doctor’s schedulingoffices
Firewall
archive
Service locations
Private officestexts
e.g. Mayo, TDS
e.g. Mayo, TDS
emailovid
Hospital floors
UPHSnetfrom
HUP to 3440 Market
170.212.11.25255.255.255.252
0.0.0.0Port 2/24
170.212.11.38255.255.255.252
0.0.0.0Port 8/23
170.212.11.37255.255.255.252
0.0.0.0
170.212.251.5255.255.255.128
0.0.0.0F2-1
170.212.250.201255.255.255.128
0.0.0.0F1-1
170.212.251.6255.255.255.128
0.0.0.0F2-1
170.212.250.205255.255.255.128
0.0.0.0F1-1
100base fx
3440B
OSPF area0.0.1.8
3440A
OSPF area0.0.0.5
170.212.11.29255.255.255.252
0.0.0.0Port 7/3
170.212.11.26255.255.255.252
0.0.0.0Port 1/8
170.212.11.30255.255.255.252
0.0.0.0E5-1
3440C100 TX Full
170.212.11.34255.255.255.252
0.0.0.0E8-1
170.212.11.33255.255.255.252
0.0.0.0Port 6/3
170.212.251.16255.255.255.128
0.0.0.0F2-1
170.212.250.208255.255.255.128
0.0.0.0F1-1
170.212.250.202255.255.255.128
0.0.0.0F1-1
170.212.251.4255.255.255.128
0.0.0.0F2-1
170.212.11.42255.255.255.252
0.0.0.0Port 1/3
170.212.11.41255.255.255.252
0.0.0.0E5-2
100 T
X ful
l
GIG
GIG
170.212.11.69255.255.255.252
0.0.0.0Port 7/23
170.212.11.70255.255.255.252
0.0.0.0Port 2/1
170.212.11.78255.255.255.252
0.0.0.0Port 1/2
170.212.11.77255.255.255.252
0.0.0.0E8-2
170.212.11.74255.255.255.252
0.0.0.0Port 6/1
170.212.11.73255.255.255.252
0.0.0.0Port 3/1
170.212.11.57255.255.255.252
0.0.0.0Port 7/24
170.212.11.58255.255.255.252
0.0.0.0E 6-3
STG 4
ToRadNet
100 FXFull Duplex
E 6-1 170.212.135.2255.255.255.0
0.0.0.0E 8-2
100 FX1/2 Duplex
100TX1/2 Duplex
DRAWN BY:
REVISED:
DATE:
CUSTOMER:
FILE:DESCRIPTION:
04/10/00
topo_hup_08-16-01.vsd
02/11/02
Kevin Stead
UPHS
Connectivity from 3440Market St.
to 3400 Spruce St.
100base fx
3440D
CSC 4
OSPF area 0.0.0.7
CSC1
OSPF area 0.0.0.6
CSC 3Port 1/1Tagged
Port 1/1Tagged
G Ring F Ring
CSC2
OSPF area0.0.0.7
100 TX1/2 Duplex
170.212.11.14255.255.255.252
0.0.0.0Port 4/2
170.212.11.13255.255.255.252
0.0.0.0E 8-1
Page 1/1
Current network issues
• Consolidation of health systems– Columbia– UPHS
• Niche products vs. integrated products
Examples of Networking
• Orlando Regional Healthcare System– One stop shopping for all kinds of healthcare
• Ohio– Community Health Information Network
• 20 hospitals• 2400 doctors• 1.4 million people
Examples
• Shands Hospital– Patient movement– Information about referring MD’s– Coordinated clinic scheduling– Online EPR
Examples
• Asynchronous Transfer Mode (ATM) nets– Unlimited bandwidth on demand– Integration of voice, data and video– Seamless integration of systems– Well-defined quality of service
• Perfect for consultation– Radiology, lab
Examples
• Gigabit ethernet– Interactive cardiac testing– Surgery Cam (QOS issues)
