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

Limerick

PAREMOTE

SITES

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

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3440A

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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

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0.0.0.0Port 7/23

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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

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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)