Huadong Hospital CIO talks about the difficulties in promoting hospital information systems

"From the perspective of Party B, there are many incomprehensible problems in the hospital's information system, and the root causes of these problems must be found from Party A." Gu Baojun, director of the Information Center of the East China Hospital affiliated to Fudan University in Shanghai, said in an interview with HC3i reporters.

Looking back at the development of medical informatization in China, Director Gu noticed such a phenomenon: "Around 2000, hospitals had no idea about informatization construction. During this period, software companies guided hospitals and hospitals passively accepted informatization. Now, hospitals' demand for informatization has surpassed that of software companies. The bottlenecks of information systems in each hospital are different. To break through these bottlenecks, the professionalism of the information center is very critical."

The Importance of Information System Planning

Most hospitals' information centers are understaffed with professional technicians, and their daily work can only cope with daily maintenance work and information needs arranged by leaders. The biggest problem brought about by this passive working style is the lack of a real understanding of the overall situation of the hospital information system. As the director of the information center, under the pressure of passive work, you must actively carry out information system research and planning work, find the pain points of the hospital information system, and find ways to gradually improve it.

Information center staff do not use HIS, PACS, EMR and other information systems every day, and do not understand the real feelings of users. Therefore, the best way to understand the problems of these information systems is to actively investigate the use of the systems. Listen carefully, think carefully, and find out the gap between the system and the users. Another benefit of doing so is that it shortens the distance between the information center and the business departments.

Hospital information systems and management have a complex relationship. One of the important tasks of good information management is to communicate with various business departments and discuss the way to combine information systems with management. As an information center, you must not be afraid of communication, but be good at communicating with business departments. For example, the consistency of hospital statistical caliber requires a lot of research and communication work.

With the research as a foundation, hospital information planning should be gradually formed. Information system planning is a long-term task and should not be started at the time of annual planning. It should be gradually formed on the basis of research. The planning should be as detailed as possible. For example, for the problem of information islands, the definition of each business that needs information exchange should be detailed. In this way, with continuous accumulation, it is possible to gradually make the information system close to the overall needs of the hospital.

Clinical-centered hospital information system

Regarding the current situation of domestic hospital information construction, Director Gu believes: "Future information construction is not just about installing a complete system. The key to whether an information system is good or bad is still clinical application." It is not just about installing a complete system. The existing hospital information system only completes basic functions; nor can it be achieved by buying a new system. There are still many higher-level functions that need to be developed and improved by the information center. In building a hospital information system centered on clinical practice, the status of the information center is crucial.

Taking the clinical information system as an example, clinical information construction is one of the key points of Huadong Hospital's information construction next year. Now when doctors use the doctor workstation to record medical orders, junior doctors record whatever the senior doctors say. The main function of the system is to record, and doctors are not very willing to use it. "The medical order entry platform we want to build is to truly become a doctor's working environment, not just an entry platform." Director Gu said, "A doctor with diabetes pays attention to blood sugar and hypoglycemic drugs. These things can become a template to see how the patient's condition changes after using these drugs."

Is it useless to input clinical data into the server through the doctor's order platform? No, analyzing this data is very helpful for the long-term observation of patients' conditions, the development of medical disciplines, and clinical drug research, which requires clinical data mining and analysis, and also requires the support of clinical information systems.

At present, the clinical pathway management pilot project is being promoted in China. The clinical pathway system requires a large amount of clinical data. A good data foundation is the foundation of the clinical pathway system. We have seen that some clinical pathway systems now use PDF files as the basis, and some applications cannot be made.

Doctors also have ideas about the electronic medical record system. They believe that the current electronic medical record system has a weak understanding of clinical practice and cannot provide diagnostic references or other auxiliary functions. For example, if a patient needs surgery, the system should provide some basis for why he needs surgery by analyzing his symptoms. If he needs surgery the next day, the system should check it once or remind him what needs to be checked carefully the day before. These can help doctors reduce the misdiagnosis rate, and doctors welcome these functions.

Issues of durability and standardization of electronic medical records

"The current application of electronic medical records is still far from the requirements of the Basic Specifications for Electronic Medical Records." Gu Baojun, director of the Information Center of East China Hospital, expressed the above views to reporters when talking about the promotion of the electronic medical record pilot project.

The Ministry of Health has launched a pilot project for electronic medical records in the country, which has once again set off a wave of electronic medical record system construction in medical institutions across the country. Director Gu believes that there are still many bottlenecks to be overcome in the domestic electronic medical record system.

Persistence of electronic medical record data. Persistence means that data does not change with time and place. Electronic medical records record several aspects, such as doctor's diagnosis documents, medical orders, test reports, patient information, etc., which are stored in different databases/tables. There is a certain relationship between these databases/tables, and the correlation between data is very high, so it is difficult to achieve data staticization. If the medical order database is modified or moved, it may cause data loss or data relationship confusion in several other relational databases/tables, and the data of the entire electronic medical record system will be lost. If the electronic medical record data is converted from database management to document management, so that the electronic medical record is no longer dependent on each subsystem, it will not affect the persistence of the entire electronic medical record.

Standardization of electronic medical records. The rich content, variety and diversity of electronic medical records have made them the focus of the digital medical industry, which also makes it difficult to break through the problem of electronic medical record standardization. No manufacturer is willing to disclose the source code of their own system, the interface procedures between systems are complicated, there is no unified standard, and it is difficult for different electronic medical record systems to interact and share data. In the absence of standards, we call on the competent authorities to gradually establish evaluation standards for HIS systems, make interface opening an important content, and reduce the risks of shared integration of hospital information systems.