HCIS 140 Week 4 Health Care Information Systems Example

The Systems Around the Record: Following a Chest Pain Visit Through Registration, Laboratory, Imaging, Pharmacy and Exchange Systems in a Community Hospital

[Student Name]

University of Phoenix

HCIS/140: Fundamentals of Electronic Health Records

Week 4 Assignment

[Instructor Name]

[Date]

The hospital, the patient and the systems described are composites written for a model paper; standards and findings come from the sources listed.

At 9:15 on a Tuesday evening, a 58-year-old woman arrives at a community hospital's emergency department with chest pressure. Over the next four hours, she will be registered, examined, tested, imaged, treated and either admitted or discharged, and her information will pass through at least six information systems besides the electronic health record. This paper follows her visit to show what each system does, what it exchanges with the EHR and what happens when a connection fails.

Registration and the Master Patient Index

The registration clerk searches the master patient index, which gives every patient a single medical record number across the hospital, and finds her from a visit two years ago. Her demographics and insurance are updated in the registration system, which sends an admission message to the EHR, laboratory, radiology and pharmacy systems so each knows she is here. Failure example: if the clerk had created a new record instead of finding the old one, her past results and allergy list would be split across two charts, and a clinician might miss her penicillin allergy.

The Laboratory Information System

The physician orders a troponin test, a marker of heart muscle damage, in the EHR. The order travels to the laboratory information system, which prints a specimen label. The nurse draws blood and the analyzer runs the test, sending the result to the laboratory system, where a technologist verifies it before it posts to the EHR within 40 minutes. A result above the critical threshold would trigger a phone call to the physician. Failure example: if the interface stops, results sit in the laboratory system and never reach the physician's screen, so the laboratory runs an interface monitor that alerts staff when messages queue up.

Radiology Information System and Image Archive

A chest X-ray is ordered in the EHR and received by the radiology information system, which schedules and tracks imaging. After the image is taken, it is stored in the picture archiving and communication system, where the radiologist views it and dictates a report that returns to the EHR. The emergency physician can open the image from within the chart. Failure example: if the order and the image carry different patient identifiers, the image may be filed to the wrong patient, which is why technologists confirm identity with two identifiers.

Pharmacy System and Dispensing Cabinets

The physician orders aspirin and nitroglycerin. The pharmacy system receives the order, a pharmacist verifies it against her allergies and other medications and releases it to the automated dispensing cabinet in the emergency department, where the nurse removes the dose by scanning her badge and the patient's wristband. Each administration is documented back in the EHR.

The Health Information Exchange

Because she had a cardiac catheterization at another hospital last year, the physician queries the regional health information exchange and retrieves the catheterization report and her last echocardiogram. Without the exchange, the physician would have ordered some tests again or waited for faxes, so a connection between two organizations' systems directly shaped her care that night.

Billing

When she is admitted for observation, the visit's charges from each department flow into the hospital's billing system, where coders assign codes from the documentation and a claim is later sent to her insurer, closing the loop that registration opened.

Standards That Tie the Pieces Together

Systems from different vendors can exchange data because they follow common standards. HL7 version 2 messages carry admissions, orders and results among hospital systems and have done so for decades. The newer Fast Healthcare Interoperability Resources standard, known as FHIR, uses modern web technology to share data, including through application programming interfaces that patients and outside applications can use (HL7 International, n.d.). Standard vocabularies, such as LOINC for laboratory tests, make sure a result means the same thing in every system.

Clinical Decision Support Across Systems

Several systems combined to protect the patient that night. The pharmacy system checked her aspirin order against her allergy list, which came from the EHR, which in turn had been updated from the exchange. If her troponin had been high, the laboratory system's critical value rule would have triggered a call, and the EHR's chest pain order set would have prompted the physician to consider a cardiology consult. None of these safeguards lives in a single system; each depends on data flowing correctly among several.

Downtime Across Systems

When one system goes down, the others must cope. If the laboratory system fails, the emergency department switches to paper requisitions and phoned results; if the EHR fails, the laboratory continues testing and holds results until the connection returns. Each department keeps downtime procedures that assume another department's system may be unavailable.

Why the Connections Matter

Each interface is a place where information can be delayed, duplicated or lost. Electronic systems bring faster results and fewer transcription errors, but they also bring new risks when connections fail, along with costs for building and maintaining them (Menachemi & Collum, 2011). Hospitals employ interface analysts whose job is to watch these connections day and night, fix stalled message queues and test every change before it reaches live systems.

What the Visit Shows

In four hours, one patient's information moved through registration, laboratory, radiology, pharmacy, exchange and billing systems, all linked to the EHR. The record was the center, but it depended on every system around it and on the standards that let them speak. The EHR is meant to travel with the patient among the organizations that provide care (Office of the National Coordinator for Health Information Technology, 2019), and that sharing happens through exactly these connections.

Conclusion

The electronic health record is only part of a hospital's information systems. Registration, laboratory, radiology, pharmacy, exchange and billing systems each do specialized work and trade data with the record through standard interfaces. Understanding these systems, and where their connections can fail, is essential for anyone who manages or supports health care technology.

References

HL7 International. (n.d.). FHIR overview. https://www.hl7.org/fhir/overview.html

Menachemi, N., & Collum, T. H. (2011). Benefits and drawbacks of electronic health record systems. Risk Management and Healthcare Policy, 4, 47-55. https://doi.org/10.2147/RMHP.S12985

Office of the National Coordinator for Health Information Technology. (2019). What is an electronic health record (EHR)? HealthIT.gov. https://www.healthit.gov/faq/what-electronic-health-record-ehr