Information Technology in Healthcare

Dr Keith Boardman

Director of Computer & Network Services

University Hospitals Coventry & Warwickshire NHS Trust

The NHS as a Business

National Health Service Formed in 1948 Employs 1 million people 500 health authorities Costs £37 billion Treats 8.4 million in-patients a year About 3 million day-cases a year 40 million out-patient attendances 30,000 GPs

UHCW NHS Trust

Acute Trust with 1246 beds11 Regional SpecialitiesMeets 98% of Coventry & Rugby acute

healthcare needsContract Income £200M approx.6000 employees

Urology General Surgery Ear Nose & Throat Ophthalmology Oral Surgery Orthopaedics Rheumatology Dermatology General Medicine GP Maternity Gynaecology Special Care Baby Unit Paediatrics Obstetrics

Cardiac Surgery Thoracic Surgery Cardiology Renal Transplantation Renal Dialysis Neurology Neurosurgery Radiotherapy Bone Marrow Transplantation Haemophilia Services Neonatal Intensive Care

General Specilaties Regional Specialties

In-patient attendances - 90,000 Out-patient attendances - 306,000 Emergency assessments - 27,000 Accident Dept attendances - 103,000 Pathology requests - 865,000 Radiology Examinations - 207,000 MRI & CT Scanning - 13,000 Patient meals - 1,400,000 Staff meals - 744,000

Activity Levels

Computers in HealthcareKey application areas:Information ManagementTreatmentDiagnosis

Information ManagementHospital Administration SystemsCommunity & GP SystemsClinical Information SystemsBusiness Systems

Hospital Information SystemsA HIS meets the real-time operational information needs of health professionals to deliver care to patients, whilst also providing accurate and timely information for management purposes.

HIS Benefits Improved care and delivery of services

provided to patients Reduced administrative work Better information for resource

management

HIS Functional areas(used by 1500 staff)

Patient Administration Admissions, Discharges and Transfers Accident & Emergency Maternity Operating Theatres Professions Allied to Medicine Case Note Tracking Contracting & Billing

HIS Computer System:HP9000/K460 running UNIX•2 G Byte RAM

•100 G Byte disk storage (RAID)

•128 V24 ports

•IEEE 10/100 MHz Ethernet

•Cartridge Magnetic Tape

•DLT Magnetic Tape

Radiology Clinical DocumentationPathology

Clinical Information SystemsClinical Information Systems

Clinical InformationSystem

Intranet &Internet

HIS HP9000

CommunityHP 9000

Breast Scr’HP 9000

PathologyRS6000

PharmacyRS6000

RadiologySun

RenalHP 9000

MIS General E-Mail

Computer Systems Overview

PC ClientAccess

Local Area Network (with ATM backbone)

HIS

Pathology System Radiology

InterfaceEngine

Clinical System(Data Warehouse)

Local Area Network (with ATM backbone)

PC ClientAccess

DATA INTEGRATION

SecureGateway

NHSnet Intranet

Internet

Wide Area NHS Communications

Information for Health

An Information Strategy for the Modern NHS 1998-2005

Top level commitment

“The challenge for the NHS is to harness the information revolution and use it to

benefit patients”.

Rt. Hon. Tony BlairAll Our Tomorrows Conference 2 July 1998

Purpose of the strategy

. . . . to put in place over the next seven years the people, the resources, the

culture and the processes necessary to ensure NHS clinicians and managers

have the information needed to support the core purpose of the NHS. And to ensure the public and patients have a range of quality information easily accessible about health and

health services.

Treatment and care

Primary careEHR

PublicPatientsHealthcare professionalsManagers

Knowledge for

Public healthClinical GovernanceHealth Improvement ProgrammePerformance management

Analysis

Socialcare

records

NHSTrustEPR

Defining electronic records Electronic Patient Record - a record of

periodic care provided by one institution, typically an acute hospital

Electronic Health Record - the concept of a longitudinal record of a patient’s health and healthcare to combine information from primary healthcare with periodic care from other institutions

4 Key Pieces of the Strategy

Better Practice Systems +Electronic Health Record

( EHR )

Better Hospital Systems +Electronic Patient Record

( EPR )

National ElectronicLibrary of Health

( NELH )

INFRASTRUCTURE(wires,security,standards)

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Computers in Healthcare

Key application areas:

Information Management

Treatment

Diagnosis

Computers used in TreatmentRadiotherapyIntensive CarePatient Communication AidsProtheses

Computers in Healthcare

Key application areas:

Information Management

Treatment

Diagnosis

Computers used in DiagnosisComputerised TomographyMagnetic Resonance ImagingUltrasonicsRadioisotope Imaging

MedicalImaging

Computerised Tomography

Intracranialhaematoma

Renaltumour

Magnetic Resonance ImagingProtons in a magnetic field have a microscopic magnetization and act like tiny toy tops that wobble as they spin. The rate of the wobbling or precession is the resonantor Larmor frequency. In the magnetic field of an MRI scanner there is approximately the same number of proton nuclei aligned with the main magneticfield as counter-aligned.On a macroscopic level, exposure of an object or personto RF radiation at the Larmor frequency, causes the net magnetization to spiral away from the static field.Relaxation is the process whereby nuclear magnetization returns to its resting state following a perturbation, such as by an RF pulse.

An MRI Scanner

Magnetic Resonance Imaging

Lumbar Spine

KneeAnatomy

Baker’sCyst

Ultrasound Imaging

Ultrasound Imaging System

Pregnancy

Triplets

Liver carcinoma

Nuclear Medicine Imaging

ConventionalRadiography

Gamma Camera:Pulmonary Embolism

THE END