The exchange of health information is a critical component of healthcare service provision. All modern healthcare institutions have an integrated patients’ information management system. These systems store patient’s records in electronic format for retrieval by the care providers in various departments. The electronic exchange of patients’ information has many advantages. It enables the care providers to get patients’ medical records in a timely manner. Thus, it helps improve the quality of medical services provided by the institution. It also minimizes costs by reducing incidences of repeat tests. Moreover, it facilitates the transfer of patients’ records to insurance companies. The quick transfer of information reduces the time taken to processes medical insurance claims.
The exchange of patients’ information at the hospital is facilitating by the Electronic Health Record (EHR) technology. This technology stores electronic data in tables referred to databases. Databases store data in a structured manner that hastens the retrieval process. EHR software runs on computers called servers. Consequently, the speed and the data transfer rate of the server have influence on the performance of EHR software. Currently, the hospital is using four Dell 850 servers with a processor speed of 2.53Hz, two 5721J Network Interface Controller and 250 gigabytes disk space. These servers are based in each department, admitting, laboratory and pharmacy and clinicians. Consequently, each department has its own information system. . The non integration of the IT systems within the hospital has hampered communication and information flow between the departments of admitting, laboratory, pharmacy and clinicians.
The information sharing infrastructure used by the hospital was built in the year 2010. This infrastructure did not focus on the coordination of information flow between the departments. Consequently, the coordination of information flow has remained unplanned. The IT department proposed that the hospital should procure additional server to be used for coordinating the exchange of information between admission, pharmacy, and laboratory and clinician department. This server shall host all the information stored in departmental servers, and it shall be referred to the central server. The department endorsed HP ProLiant DL585 G7 Server. This HP server is powered by 12 core AMD Opteron 6000 processor. It has a speed of 2.6 gigahertz and internal disk space memory of 512 gigabytes. It comes with 1.5 terabytes DDR3 RAM that is expandable. These specifications give it the capability to process enormous workload. Besides, the server has a four Network RJ-45 Ethernet slots each with 10 GB/s data transfer rate (“HP ProLiant DL585 G7 Server”, n.d). The server’s data transfer rate is four times the departmental servers. .
Apart from the new server, the IT department is of the view that the hospital should buy a modern router. A router is communication device that distributes data packets within the network. The network consists of all devices that are connected to the server. The router shall enable the devices based in admission, pharmacy, and laboratory and clinicians department to connect directly to the central server through wireless technology. The department endorsed Cisco 3845 Integrated Service Router that comes with in-built security features. The router has two 1000 MB/s in-built in routed ports and 112 100Mb/s switch ports (“Cisco 3845 Integrated Services Router”, n.d).
The proposed infrastructure changes shall be done in phases. The phased approach was preferred because it provides the best implementation strategy that has minimized chances of service. The hospital cannot afford to shut down its system for the upgrade because the clinicians cannot carry their duties without patients’ data. The information in departmental servers shall be duplicated in the old server without interrupting services. Once, all the data has been copied to a central server, the server shall be switched on.
All the departments, admitting, pharmacy, laboratory and clinicians already have the necessary software and hardware needed for information sharing. The central server and router shall facilitate coordination of information flow between these departments. Data that is referred to as message by Health Level standard shall be moved from the server to the computers and devices located in the departments. The devices will be required to open IP socket with the server. This process requires authorization done by the system. Once, the authorization has been conducted and connection is established, the server shall deliver the message to the client who shall be expected to acknowledge the receipt. HL 7 standard demands that the communication should be secure (Chinniah & Muttan, 2012).
The information exchange between the departments of laboratory, admitting, pharmacy and clinicians shall adhere to Health Level 7 specifications on health information exchange. The transmitter of patient’s information shall be identified by the login information details stored in the system. The message sent over the network shall consist of the header and the receiver. The header shall be the hospital while the receivers shall be the care providers authorized to access the information. Other segments shall include the patient identification segment with patient name and other personal details. Pharmacy administration, lab administration and clinician administration and admitting administration segments shall also be included in the message. .
The hospital shall use five message types for purposes of batch processing. UDT-type for sending updates on patients’ personal information. A KT-type for acknowledging delivered messages. ANT-type for sending patients updated medical plus demographic information. ADT-type messages for admission, discharge and transfer and ACT-type for deleting patients’ records. All the messages transmitted over the network shall be encoded for security reasons. The use of message types is provided for by HL 7. This standard improves interoperability because it has recommended organized and structured way of storing data that makes it easier for information retrieval. The standard is observed by over 100 countries in the world.
Incorporating the interoperability mandate from the office of the National Coordinator shall present many challenges. First, it will require expansion of the hospital network because this office is not housed within the hospital. An expanded network is prone to hacking and system errors. Besides, the integrity of information cannot be guaranteed under this arrangement. The office of the national coordinator may use the patients’ information for purposes that are not described in the health records regulations. This practice can be minimized through legislation that provides strong deterrence to abuse of privacy. The IT challenges can minimize through investment in modern hardware and applications. These applications have elevated security features.
In conclusion, it is worth mentioning that the urgently require an upgrade of infrastructure to facilitate communication and coordination of information flow between the departments. Currently, departmental systems are not integrated. Meaning that, a person in need of patient’s information has to access it through the departmental servers instead of a centralized server. To this end, the IT department proposed that a central server and router be bought to facilitate coordination of information flow between the departments of pharmacy, admitting, laboratory and clinician departments.
References
Chinniah, P. P., & Muttan, S. S. (2012). HL7 standard based Hospital Information System. International Journal Of Biosciences & Technology, 532-39.
Cisco 3845 Integrated Services Router. (n.d.). Cisco. Retrieved March 31, 2014, from http://www.cisco.com/c/en/us/products/routers/3845-integrated-services-router-isr/index.html
Dell PowerEdge 850 Server. (n.d.). Dell Servers. Retrieved April 1, 2014, from http://www.dell.com/downloads/ap/products/servers/en/850_spec_sheet.pdf
HP ProLiant DL585 G7 Server. (n.d.). HP. Retrieved March 31, 2014, from http://www8.hp.com/us/en/products/proliant-servers/product-detail.html?oid=4194641#!tab=features
