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Intranet Technology in Hospital Information Systems James J. Cimino, M.D. Department of Medical Informatics Columbia University Accessing Clinical Information over the Internet and World Wide Web James J. Cimino, M.D. Department of Medical Informatics Columbia University Web Access to the EMR at Columbia-Presbyterian Medical Center James J. Cimino, M.D. Department of Medical Informatics Columbia University CPMC in 1988 - preTCP/IP IBM Mainframe Data Repository Data Monitor Ancillary Systems Vocabulary Server Results Review Clinicians CPMC in 1991 - TCP/IP IBM Mainframe Data Repository Data Monitor Vocabulary Server Results Review Intranet Upload Engine Minicomputer Vocabulary Server Ancillary Systems Minicomputer Clinical Application Vocabulary Server Clinicians CPMC in 1994 - WWW IBM Mainframe Data Repository Data Monitor Intranet Minicomputer Internet Knowledge Resources Web Server Vocabulary Server Clinicians Clinical Database • Row-oriented relational database (DB2) • Flexible and extensible • Clinical data coded with MED • Multiple time stamps Data Monitor - Input and Alerts • Stores all data in repository • Checks data for triggers • Executes Medical Logic Modules • Stores alerts in database Clinical Database Server - Output • Dynamic queries (SQL) • Canned queries – Time span – Last "n" results • Class-based retrievals ("get all positive culture results") Medical Entities Dictionary (MED) • 56,000 medical concepts • 82,000 synonyms • Multiple hierarchy (72,000 links) • Semantic network (43,000 links) Calcium Preparations Calcium Serum Calcium Intravascular Calcium Tests Plasma Calcium Abnormalities of Calcium Hypercalcemia Hypocalcemia MED Server • Lexical searching • Concept attributes • Classes • Ancestors Web Server • Clinical database queries • Vocabulary server queries – Class queries – Translation • HTML document generation • Applets • Web links CPMC’s Web EMRs • Elpis - single patient view • PolyMed - service view • WebCIS - multiple views Web EMR Features • • • • • • • • Frame-based interface Summary reporting Graphical displays Multimedia displays Cross-patient displays Order entry Integration of on-line resources Security and confidentiality screen shots • • • • • • • • patient list departmental screen headers - lab details - lab lab summary lab graph radiology - detail dop - detail • • • • • • • • alerts cardiology - detail ecg multi-patient summary lab order entry pharmacy list pharmacy rx time view Integration of On-line Resources • • • • • • • • • Lab to Medline Lab to PDR Lab to disease description (DXplain) Lab to differential diagnosis (DXplain) Lab to guideline (cholesterol) Drug to dietary restriction information Drug to PDR X-ray to Medline X-ray to Web information sources screen shots of integration • • • • • • • Lab to disease description (DXplain) Lab to differential diagnosis (DXplain) Lab to guideline (cholesterol) Drug to dietary restriction information Drug to PDR X-ray to Medline X-ray to Web information sources Security and Confidentiality • User logon name and password • Encryption (SSL) • Logon screen ID (single use) • Session screen ID (expires) Current Challenges • Application development • Navigation of hypertext • No control over client machines • Resource integration • Hospital mergers parting shot - carmen sandiego lab