ENHANCEMENT TECHNOLOGIES TO
IMPROVE THE PEFORMANCE OF CLINICAL INFORMATION SYSTEMS

Introduction

One of the major efforts of the Health Information Technologies Research Laboratory has focussed on developing "bolt on" or enhancement technologies which would improve the performance of clinical information systems. 

The technologies are called "enhancement" because they do not replace the clinical information systems currently in use within an organisation, but rather bolt on to the side of the host clinical information system and interface with it to enhance the use of its information. By being "bolt on" the technologies ensure the integrity of original clinical information systems and their data are not compromised by modification in any way, thus making the whole process risk free.   

The enhancement technologies work by interpreting the clinical information in a smarter way, converting it to a more meaningful and standardised information set by providing mechanisms for analysing the resulting information for patterns.  Technically, they use two types of tools to achieve their purpose. They use language processing, ontology and classification algorithms which have been developed specifically to analyse the text in the clinical  systems, and they use specially developed tools  to reverse engineer and catalogue all the data defined in the host system.  Given the immense value of the data in clinical information systems and the risk profile of that data, the HITRL team decided to create new technologies that aimed at providing a productivity gain for the users. The Laboratory also conducts research on semi-automatically generating compact and highly specialised clinical information systems from specifications founded on clinical ontologies.

The team at the Laboratory has tackled the hard problems of clinical data processing and enhanced the functionality in a way that does not require people to change work practices and engage in costly and time consuming retraining. At the same time the new enhancement technologies provide pathways to increased productivity without any risk to existing infrastructure and mission critical systems.  Listed below are the current technologies available for use that have emerged from the Laboratory to date.

The individual enhancement technologies are listed below:

(Deployment of these technologies would take approximately  3-12 months duration)

•1.      Ward Rounds Information Systems (WRIS)

•2.      Handovers Information System 

•3.      Clinical Data Analytical Language (CDAL)

•4.      Patient Tracking and Workflow

•5.      Rescuing Data from Legacy Systems

•6.      Structured Reporting - Pathology

•7.      Compact Customisable Information Systems

•8.      Automated Coding of Medical Records

•9.      Nursing Clinical Information System (N-CIS)

These bolt on technologies are now mature with significant credentials.  They have been developed and tested through  50+ completed projects with organisations including Sydney West Area Health Service (Westmead Hospital, and the NSW Breast Cancer Institute), Royal Prince Alfred Hospital, South East Area Laboratory Services, South West Area Pathology Services, and the National Centre for Classification in Health.

A Note on WRIS & CDAL Technologies

WRIS & CDAL are our lead enhancement technologies at the moment and can be readily rolled out onto existing host clinical information systems. They appear on the surface to rely on the presence of an existing EMR in a hospital, which can be raised as an objection to the deployment of this technology as most hospitals consider they don't have an EMR. Part of the answer lies in what you call an EMR - if you say it is everything we known about the patient then no-one has that, but if you think of WRIS and CDAL working on ANY clinical information system then there are lots of them in many hospitals.

An extension of WRIS/CDAL is that they can operate across multiple CISs so there is the benefit  of an "information exchange"  that interconnects  ALL (or MOST) extant clinical information systems for information extraction and retrieval. You will want this regardless of any other technology you introduce.

Also where departments or role groups (e.g. nurses, physios, allied health, psychs, etc) don't have any clinical information system this technology can be an opportunity to incrementally introduce an EMR. This happens by using our compact clinical information systems for data entry in the sense of being a text editor that prints to paper for filing in the official patient file, yet keeps the contents in our file system "as a backup" for the real file. Our system can then do retrievals on the  "copy" of the medical record. This could work very well for nursing notes for example. As our compact systems are lightweight and readily changeable, e.g. overnight, they represent an easy method of introducing EMRs at local sites and developing what you want before the full "Cerner-like" systems are created at some indeterminate time in the future.