Tag Archives: EMR

Designing Hospital IT Infrastructure For Promoting Patient Centered Care

patient-centered-careThis is a re-post of discussion I had on Quora.com .  You can read it here by clicking this link

When designing an IT system for Hospitals, you would have to consider many factors like
1. Who are main users of the systems
2. What are the legal requirements
3. What are regulatory requirements

(img courtesy : blog.slkylight.com )

4. What are security considerations you have to follow
5. Would the users need access to the systems outside hospitals organizational or IT boundaries
6. How will you protect the privacy of the data you would be storing
7. What kind of redundancy do you need and how are you going to replicate the data
8. Will you be needing to integrate with other 3rd party vendors for example EHR providers and if it is then how do you plan to integrate them. Think in terms of integration issues, data migration/replication/access etc.This should also cover the different types of software/databases you or your organization would be using.

9. How many different systems does your hospital have and what kind of data they are creating/accessing/retrieving and in what format.
10.Also think about the regular IT maintenance tasks you have to follow.
11. Think in terms of the HW reliability and backup plans.
12. What kind of latency is tolerated while doing stuff real time for your users. This will help you plan your network issues.
13. Understanding the load/performance issues of your IT depending on the expected usage will help plan on selecting right infrastructure.

Here is how I would approach : I would build a patient journey template . The moment patient wants to visit your hospital to the moment they walk out . Along the process list all the interactions they will have with your staff and what kind of IT infrastructure you need to support them. 

This should also include what your physicians will need to support the patient like clinical decision support systems.

Next, build the template from the physicians  and/or hospital administration point of view.

Also think about how to monitor the patient remotely and how to process real time alerts and what kind of infrastructure you need for that. For example those alerts or data might be passed to hospital nursing station who would then filter and send it to order .

Do this from the point of view of all users of the system (or stakeholders of the system like patients/nurse/physicians/administration) etc and by the time you are done with this exercise you will have around 6-8 templates.

Now keeping all the templates in front of you, comeup with a top-down template that comprises whole system. If there are multiple systems (in the context of IT) doing the same thing, eliminate/simply them keeping price/features/support/security/privacy/compliance in mind.

You might have to iterate multiple times to build something you can go forward.

Next introduce the hardware required to support the IT systems you selected keeping reliability/costs/power in mind. This will give you a decent understanding of what your datacenter will look like . See if the HW system costs and electricity/cooling costs still makes sense. If not revise and make tradeoffs

Next introduce the connectivity part. What components needs to be on what kind of networks. Wireless/Wired etc. Think of network security here. Figure out a strategy on how you will protect against intruders/hackers/breaches etc…

Since you are hospital, you must be using some latest and greatest surgical equipment and many of them are wired and some are wireless or require different protocols. Plan ahead for these and include this as a part of IT development plan.

Use of ipads or tablets is increasing in hospitals. There might be additional devices your staff will be using . Sort of BYOD (bring your own devices) . So think what kind of mobile device management technology you want to use and how it fits in this picture.

There might be many more, but this is pretty broad picture and this is how I would approach if I were to design/develop patient centered hospital.

Few suggestions:
1. Stick few systems and vendors if possible. This will solve interoperability issues
2. Storage plays a key role. So select right database technology and database vendor. I prefer documented oriented databases.
3. I’m really not sure if you can have open access meeting all stringent legal/compliance/privacy/regulatory req. There will be tradeoffs. Ask your startup what you will be loosing or your patients/staff will be loosing and what you will be gaining.
4. How do you plan to have CMS (content management system ) serving both patients and medical staff. You need 2 CMS systems one where patients can access and other only hospital staff/physicians can access.Its very important from legal/security point of view to separate or have them in network boundaries.
5.Since you want state of art, what kind of login access are you planning to have ? Biometric? They come with their own sets of requirements
6. Same with clinical decision support systems. Collect all the requirements each of dept needs.

Would love to know from readers on how they would approach or design an advanced hospital IT infra with patient centered care in mind…