Healthcare Information and Management Systems Society (HIMSS)

- is a nonprofit organization that works to optimize the use of technologies in a healthcare setting.
 Information systems are interrelated components working together to collect, process, store, and disseminate
information to support decision making, coordination, control, analysis, and viualization in an organization

As you can see, these definitions focus on two different ways of describing information systems:
the components that make up an information system and the role that those components play in an organization.
Let’s take a look at each of these.

 Five components:
Hardware
Software
Data
People
Process

Different types of Information system in medical:

1. Clinical Information System (CIS)
- is a computer based system that is designed for collecting, storing, manipulating and making available clinical
information important to the healthcare delivery process.
Clinical Information Systems provide a clinical data repository that stores clinical data such as the patient’s history of
illness and the interactions with care providers. The repository encodes information capable of helping physicians
decide about the patient’s condition, treatment options, and wellness activities as well as the status of
decisions, actions undertaken and other relevant information that could help in performing those actions.
2. Pharmacy Information System
- is a system that has many different functions in order to maintain the supply and organization of drugs. It can be a
separate system for pharmacy usage only, or it can be coordinated with an inpatient hospital computer physician order
entry (CPOE) system. A PIS paired with a CPOE allows for an easier transfer of information.
 A PIS is used to reduce medication errors, increase patient safety, report drug usage, and track costs. Inpatient
pharmacy information systems are used in the hospital setting while outpatient pharmacy information systems are
used in home settings for discharged patients, clinics, long-term care facilities, and home health care. Most of the
uses and capabilities of the PIS are similar for inpatient and outpatient settings. However, the outpatient PIS has a
stronger emphasis on medication labeling, drug warnings, and instructions for administration.

3. Health Information System (HIS)

- is a system designed to manage the data collected and stored in any healthcare facility. This includes doctors’
offices, private and public clinics as well as hospitals. These facilities collect, store, manage and send patients’ electronic
medical records.

Applications for prescribing:

1. Electronic medical record (EMR) systems

- an electronic record of health-related information on an individual that can be created, gathered, managed, and
consulted by authorized clinicians and staff within one health care organization.
EMRs typically contain general information such as treatment and medical history about a patient as it is
collected by the individual medical practice.
It can help identify those who are due for preventive checkups and screenings and monitor how
each patient measures up to certain requirements like vaccinations and blood pressure readings.
EMRs are designed to help organizations provide efficient and precise care.

Different types of digitized health records that contain most of the same types of information.

A. Personal health record (PHR)

- is health-related documentation maintained by the individual to which it pertains.
- contain the same types of information as EHRs—diagnoses, medications, immunizations, family medical histories, and
provider contact information—but are designed to be set up, accessed, and managed by patients.
and confiPatients can use PHRs to maintain and manage their health information in a private, secure, dential
environment. PHRs can include information from a variety of sources including clinicians, home monitoring devices,
and patients themselves.

B. Electronic health record (EHR)

- is an official health record for an individual that is shared among multiple facilities and agencies. There are government
incentives in many countries to standardize EHRs and ensure that every citizen has one.
- contain information from all the clinicians involved in a patient’s care and all authorized clinicians involved in a
patient’s care can access the information to provide care to that patient.
 Advantage of Electronic Medical Records

a. Reduced labor

 Faster review of patient data

 Less time spent calling or emailing appointment reminders
 Easier documentation using templates

b. Minimized resource consumption

 Fewer paper forms, reduced need to print physical copies

 Fewer duplicate or unnecessary lab orders
 Easier medication management

c. Improved care delivery

 Faster time to treatment

 Better medication management
 Earlier and better diagnosis
d. Easier data collection and analysis
 Faster report creation
 More thorough view of data trends
 Inventory control

e. More organizational efficiency

 Improved collaboration between partners and other providers

 Easier billing through coding applications
 Reduced risk of malpractice claims through better documentation
 More convenient and efficient:
 Easier to read and organize than physical notes
 Easier access for patients:
 Safer storage for your medical records

Disadvantages of Electronic Medical Records

a. Cybersecurity issues: While digital storage can be safer than carrying physical papers around, data breaches are
becoming much more widespread.
b. Require frequent updates: Since other healthcare professionals partnered with you, such as personal trainers and
pharmacists, may be using the same electronic health record system as you, it is essential that you keep patient records
updated after every appointment or consultation.
 Otherwise, they may check the system later to find inaccurate data without your knowledge, leading to
inappropriate approaches to treatment.
c. Restricted to computer access alone: There is far from a shortage of digital devices, and most doctors are growing
more comfortable with working digitally.
However, losing access to those devices, whether due to location or other issues such as power cut or loss of
internet access, could mean that records aren’t updated or are inaccessible for some time.
d. Doctor Comments and Medical Jargon
With patient access to medical records, all comments are visible, including negative ones.
Patients may misconstrue comments that only appear negative but, in reality, are not.
Most patients too will not know the various terminologies and shorthand used by medical professionals. The patient
may get confused and this can lead to misunderstandings.
e. Computer Luddites
Older patients may not know how to operate computers and electronic software as well as younger patients. This
unfamiliarity may confuse them.
Administrators can overcome this disadvantage easily by education and patience, ensuring that simplified training
brochures and videos are available, with designated ways for the patient to get personalized help if needed.

2. Computerized provider order entry (CPOE)

- refers to the process of providers entering and sending treatment instructions – including medication, laboratory, and
radiology orders – via a computer application rather than paper, fax, or telephone.

CPOE is a computer application that accepts physician orders such as:

• Medication
• Laboratory Tests
• Diagnostic Studies
• Ancillary Support
• Nursing Orders
• Involves electronic communication of orders
• Consultation

CPOE has several benefits. :

Reduce errors and improve patient safety: At a minimum, CPOE can help your organization reduce errors by ensuring
providers produce standardized, legible, and complete orders. In addition, CPOE technology often includes
built-in clinical decision support tools that can automatically check for drug interactions,
medication allergies, and other potential problems

Improve efficiency: By enabling providers to submit orders electronically, CPOE can help your organization get medication,
laboratory, and radiology orders to pharmacies, laboratories, and radiology facilities faster, saving time and improving
efficiency.

In short, CPOE is safer and more efficient for providers and patients.

FEATURES OF CPOE
a. Ordering .  Orders are communicated to all departments, improving response time and avoiding scheduling problems and
conflict with existing orders.
b. Patient-centered decision support. The ordering process includes a display of the patient's medical history and current
results and evidence-based clinical guidelines to support treatment decisions.
c. Patients safety features. Allows real-time patient identification, drug dose recommendations, adverse drug reaction, also
reviews and checks on allergies and test or treatment conflicts. Physicians and nurses can review orders immediately for
confirmation.

CPOE HAS MANY BENEFITS FOR BOTH PRACTICES AND PATIENTS:

1. Patient charts are not misplaced or misfiled
2. Comprehensive case documentation and medical history of patient
3. Improve patient care with clinical decision support systems
4. Access to Drug specific information that eliminates confusion
5. Reduced healthcare costs due to improved efficiencies
6. Improve communication between various departments such as lab assistants, doctors, nurses, specialists, pharmacist etc
7. Reduce errors related to poor handwriting or transcription of medication orders.
8. Patient Safety

Applications for Dispensing and Administration:

1. Bar code medication administration (BCMA) systems
- are electronic scanning systems that intercept medication errors at the point of administration.
- is an inventory control system that uses barcodes to prevent human errors in the distribution of prescription
medications at hospitals.
BCMA systems also can be used for pharmacy stocking and retrieval processes to help avoid medication dispensing errors
The goal of BCMA is to make sure that patients are receiving the correct medications at the
correct time by electronically validating and documenting medications. The
information encoded in barcodes allows for the comparison of the medication being administered
with what was ordered for the patient.

The Basic:
a. Bar code
- is a graphic representation of data (alpha, numeric, or both) that is machine-readable. -are a way of encoding numbers
and letters by using a combination of bars and spaces of varying widths. Both the lines and spaces are read, are often used to
help organize and index information or prices about an object.

b. Symbology is considered a language in bar code technology.

c. BCMA system consists of a barcode printer, a barcode reader, a mobile computer (with Wi-Fi), a computer server and
software.
* BCR (barcode reader)or scanner, also known as a POS (point of sale) scanner is a hardware input device capable of reading a
barcode using a laser. 
* Barcode printer is a hardware device capable of printing adhesive barcodes that can be attached to a product to identify it
and help keep inventory.
 Two types of barcodes:
1. Linear barcodes - "one dimensional" barcode that is made up of lines and spaces of various widths that create specific
patterns
2. 2D barcodes-  incorporate rectangles, dots, hexagons, and other geometric patterns to form scannable squares and
rectangles. 
Types of 2D Barcodes: Data Matrix Codes, QR Codes 

Advantages of BCMA system:

I. REPRESENT UNIQUE IDENTITY OF A PRODUCT 
II. ACCURACY OF DATA INPUT (ERROR FREE)
III. COST EFFICIENT 
IV. REAL TIME DATA COLLECTION
V. MEASUREMENT OF WORK IN PROGRESS THROUGHOUT THE FACTORY 
VI. RAPID ACCESS TO TOTAL PRODUCTION COSTS

Disadvantages of BCMA system::

I. System Failure may cost more delays
II. Scratched or crumpled barcodes may cause problems
III. Data must be coded in the barcode
IV. In laser scanning, durability and cost are the two disadvantages

Types of errors reduced include:

 Administering medication to the wrong patient. It’s crucial to follow hospital protocol when using a BCMA system.
Oftentimes nurses find workarounds to make their shifts a little easier. For example, placing a patient’s ID wristband on the
end of the bed or door. This can be causing great damage if a patient is moved without the medical professional’s knowledge.
 Mistaking one medication for another. Anyone who works in the medical field knows that there are thousands of
drugs on the market. They also know that a lot of them look and sound the same, but treat completely different symptoms.
 Administering the medication incorrectly. It’s not always clear how a drug should be administered. Intravenously? By
mouth? A nurse will always know thanks to the method and dosage information stored in the barcode.

Variety of ways to use barcodes.

a. Document Routing
You can batch scan documents with barcodes and save the documents into different groups based on the barcode value

b. Inventory
For inventory, barcodes are useful for tracking medical devices or implantable devices. Medical devices are costly and
represent significant investments that a healthcare facility makes. Using barcodes to track their location, such as when
one device is checked out or in and by whom, can help prevent their theft or misplacement.

c. Asset Tracking
Barcodes can then be used to track devices given to a patient. This can work both ways. You can track a device to each
patient it was given to and you can track who administered it. For the administrator, this can include a doctor, nurse or
other staff. For tracking where the device came from, this can include suppliers or manufacturers. These trails in an EHR
are all helpful in administering patient care or for managing device vendors and their transactions with you.

3. Robot for medication dispensing (ROBOT)

Robotic dispensing can fill 30-60% of your daily prescription volume. It does this work with extreme accuracy and safety. The
robot actually drives the workflow and eliminates chaos in both high and low volume practice settings. From the largest
hospitals in the world to the smallest retail pharmacies,

ScriptPro is freeing up pharmacists' time to provide additional patient care and create new revenue services.

When you partner with ScriptPro, you can:

 Manage employment costs and cover peak times without extra staff
 Track will call, partial fill, and out of stock prescriptions
 Dispense prescriptions safely and quietly-no air pressurized dispensing 
 Ensure no cross-contamination-dispenses directly into vial 
 Easily calibrate cells on-site when drugs change

ROBOT-Rx is a centralized drug distribution system that automates the storage, dispensing, return, restocking and crediting of
unit-dose, bar-coded inpatient medications.
 4. Automated Dispensing Machines (ADM)

- are a computerized drug storage device.

ADCs allow drugs to be stored and dispensed near the point of care while the control and track the drug distribution.
Hospital pharmacies have traditionally provided drugs to the wards through the ward-stock system. The ADCs are designed to
replace non-automated ward stock storage and have facilitated the transition to alternative delivery models and more
decentralized medication distribution systems. ADCs can improve patient safety and the accountability of the inventory,
reduce costs and lead to increased nursing and patient satisfaction. Because automated dispensing cabinets track user access
and dispensed medications, their use can improve control over medication inventory. The real-time inventory reports
generated by many cabinets can simplify the filling process and help pharmacy track expired drugs.

Automated Dispensing Cabinets Manufacturers

When looking at this market, we should consider that there are several product lines, including:

 Medication dispensing, administration, and management

 Supply distribution and management
 Cath Lab supplies
 Anesthesia carts
 Health Data Analytics

Company
AcuDose- is the third largest pharmacy
automation product line. Their dispensing units
Pyxis- This technology was initially built as an have been recently redesigned, and offer a
extension of their medication products, feature that allows nurses to hold their place in
the workflow if they get interrupted and have to
come back later.
Omnicell- had clear Plexiglass-like panels on
most sides, making it easier to see supplies.
They also made it faster to get in, get supplies,
CAPSA
and log out, and used a patented “guiding
lights” technology to help users locate supplies
in the cabinets.

5. electronic Medication Administration Record (eMAR)

- Technology that automatically documents the administration of medication into certified EHR technology using
electronic tracking sensors (for example, radio frequency identification (RFID)) or electronically readable tagging such as bar
coding)
Using HCS eMAR, clinicians can document medication administrations, vital signs, and other observations. Alerts are displayed
immediately if clinical actions need to be taken.

benefits of eMAR include the following: 

 Less emphasis on paperwork and more time spent with the patient, which increases efficiency;
 Less administrative errors, with changes being recorded instantly;
 More accurate documentation of a patient’s vital signs, problem lists, pain scales and other information;
 More accurate medication records and other patient history, using medication and other barcodes for quick scanning
and reporting options;
 Reminders to pass along to the patients, including overdue medications, reports needed and more;
 A friendly interface that multiple users can feel comfortable using;
 Modifications and settings that each user can change to accommodate their own industries and preferences;
 Availability on wired and wireless networks and in several hardware options, such as desktop computers, laptops and
handheld devices with touch screens;
 Easier reporting to superiors and patients.