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A study on building data warehouse of hospital information system LI Ping†,WU Tao† ,CHEN Mu,ZHOU Bin and XU Wei-guo* School of Economics and Management, Tongji University, Shanghai 200092, China(Li P) Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China(Wu T, Chen M, Zhou B and Xu WG) †These authors contributed equally to the article. *Correspondence to: Dr. XU Wei-guo, Xinhua Hospital, 1665 Kongjiang Road, Shanghai 200092, China(Tel:86-21-6579000. Email: [email protected]) This study was supported by the Scientific Research Plan Projects of Science and Technology Commission Foundation of Shanghai ( No. 09dz1500306). Keywords: hospital information management; hospital information system; data warehouse; online analytical processing Abstract: Objective Existing hospital information systems with simple statistical functions cannot meet current management needs. It is well known that hospital resources are distributed with private property rights among hospitals, such as in the case of the regional coordination of medical services. In this study, to integrate and make full use of medical data effectively, we propose a data warehouse modeling method for the hospital information system. The method can also be employed for a distributed-hospital medical service system. Methods To ensure that hospital information supports the diverse needs of health care, the framework of the hospital information system has three layers: datacenter layer, system-function layer and user-interface layer. This paper discusses the role of a data warehouse management system in handling hospital information from the establishment of the data theme to the design of a data model to the establishment of a data warehouse. Online analytical processing tools assist user-friendly multidimensional analysis from a number of different angles to extract the required data and information. Results Use of the data warehouse improves online analytical processing and mitigates deficiencies in the decision support system. The hospital information system based on a data warehouse effectively employs statistical analysis and data mining technology to handle massive quantities of historical data, and summarizes from clinical and hospital information for decision making. Conclusions This paper proposes the use of a data warehouse for a hospital information system, specifically a data warehouse for the theme of hospital information to determine latitude, modeling and so on. The processing of patient information is given as an example that demonstrates the usefulness of this method in the case of hospital information management. Data warehouse technology is an evolving technology, and more and more decision support information extracted by data mining and with decision-making technology is required for further research. In recent years, hospital information systems have been widely used in major hospitals for the management and accumulation of clinical data1–4. Current hospital information systems with simple statistical functions cannot meet the increasing demands of hospitals5. In general, the development of the hospital information system has gone through two stages6–8. (1) The development of local area networks, such as charging system. Information is shared within a system but not among systems. (2) The application of modern hospital information systems. Through the establishment of a hospital information system, an overall framework is built to facilitate the flow of information and sharing of information among various systems. Current research focuses on the information-based integrated database design mode for a local hospital information resource9–11. However, hospital resources are distributed with private property rights among hospitals, such as in the regional coordination of medical services. It is impossible to integrate all hospital resources into a centralized database. It is crucial to determine how to find proper information from enormous, isomeric and even distributed repositories, and then ally them with these correlative medical services. Data such as those on patients, drugs, and doctors are needed for complex statistical analysis and for data mining techniques to summarize new knowledge or information from massive quantities of historical clinical and hospital data. Therefore, like management information systems, hospital information systems need to be based on data warehouse12–16. However, most previous works have focused on the management of medical information15. At this time, data integration using data warehouse technology is an urgent problem. The lack and distribution of medical resources is a bottleneck in the treatment of a patient with a complex condition. First, it is difficult to make medical resources reusable and open such that they can be used efficiently. Second, it is presently not possible to integrate distributed medical resources for the benefit of cooperative regional medical services. This paper focuses on this problem. METHODS Benefits of the data warehouse A data warehouse is a central repository for all or significant parts of the data that an enterprise's various business systems collect17. Some of the benefits that a data warehouse provides are as follows18–21. 1. Thematic A data warehouse provides a common data model for all data regardless of the data's source. 2. Consistency Prior to loading data into the data warehouse, inconsistencies are identified and resolved, which greatly simplifies reporting and analysis. 3. Safety The information in the data warehouse can be stored safely for extended periods of time. Overall architectural design of a hospital information system In current systems, with the development of medical affairs, managers require that the health information management system not only assists the processes involved in medical affairs but also provides data analysis to support decision making and medical diagnostics. The current hospital information system database is divided into eight functional databases according to function as show in Figure 1: an outpatient information database, clinical information database, remote medical information database, electronic medical records information database, inpatient information database, medical imaging information database, pharmacy information database, and management information database. Patient information database Clinical information database Electronic medical records information database Remote medical information database Database Inpatient information database Medical imaging information database Figure 1. Pharmacies information database Management information database Current hospital information databases. Traditional database technology, however, cannot meet the above requirements for two main reasons. On the one hand, there is inadequate storage. On the other hand, current software systems are not suitable to work out with data mining, data analysis, decision support and medical diagnostic support. A hospital information system that has multiple data sources, even distributed hospitals, provides data and information of all medical aspects, and different data sources may have different data formats. To integrate these data sources effectively requires effective technology, such as data warehouse technology. Theme-oriented data warehouse issues, and the integrated data collection of medical information can be employed to support decision making. In hospital information systems, data warehouses play an important role in the data center, working with doctor, patient and process-related data and information integration. In this way, data warehouse can be integrated as shown in Figure 2. Doctor Patient … Nurse Data warehouse Operator information Doctor information Nurse information Patient information Hospital department of information Medical records Basic information of patients In-patient information Emergency work log … Drug information Diagnostic information of patients Outpatient work log Surgery the patient information … Figure 2. Hospital information system data integration based on data warehouse. On the basis of the overall objective of the system, the system’s overall architecture is a multi-layered structure that comprises a datacenter layer, system-function layer, and user-interface layer, as shown in Figure 3. Data warehouse server Datacenetr layer Application Server System function layer Data warehouse server Datacenetr layer Web Server Web Server System function layer Intranet/Internet Application Server Intranet/Internet ... ... User interface layer User interface layer Hospital A Hospital B …… …… Hospital … Figure 3. Overall system architecture design. Microsoft Visual Studio .NET is used as a development tool, and the database uses Microsoft SQL Server software, which is widely used for the management of large database systems. Datacenter layer The first layer is a datacenter layer, which stores information. System-function layer The second layer is a system function layer, which handles the request of the client to complete some logic task. The function layer also includes a security controller. The data warehouse information system is designed to address the integration and analysis of medical data. A data warehouse can obtain and collect a high load of data from many different sources in an integrated and consistent manner. User-interface layer The third layer is the user-interface layer, where a web browser or application interface is used as the client to complete the interoperation among systems. Hospital information system for the regional coordination of medical services Figure 3 shows that hospitals A and B have set up their own datacenter, data warehouse center and corresponding hospital information system. Hospitals A and B share their information through their web servers. Hospital resources are often distributed across hospitals, such as in the regional coordination of medical services. The hospital information system is based on the hospital requirements. The representation of information through a web server is thus proposed to support the web-based regional coordination of medical services. It is impossible to integrate all hospital resources into a centralized database. An authorized worker at hospital A can visit the web server of hospital B to exchange information between the two hospitals. It is easy to transform the distributed medical resource into a reusable and open web-based resource that can be used efficiently within the system architecture. Additionally, it is convenient to integrate the distributed medical resource for collaborative medical services using the above method. Data security strategy There are two parts to the management of system security. Software security Users use the same username and password to log in to different software systems or modules. Management of database security Software prevents users from bypassing logging in directly into the database system to use data. Data warehouse modeling The data warehouse design of the hospital information system requires close cooperation among the various departments and hospitals in determining the data theme, and then detailed design and construction. The creation of the process of data warehouse model is from a relational, prescriptive model to multidimensional data model transformation process. Creation of a theme The fact table is the main entity in any future data warehouse. In this paper, the data warehouse of the hospital information management system includes the management of patient information, management of information on medical workers, management of medicine information and management of hospital business information, as shown in Figure 4. Hospital information system Hospital business information management Medicines information management Information management of medical affairs workers Patient information management Hospital business process information Health care cost information Hospital management information Figure 4. Theme of the data warehouse. The patient information management system includes the management of patient registration information and patient information. The management system for information on medical affairs workers includes the management of doctor and nurse information. The medicine information management system includes the management of drug information management, and drug storage information management, etc. The hospital business information management system includes the management of information on hospital business processes, health care costs, and hospital management. The theme of the data model is shown in Table 1. The data model includes a fact table and latitude table. The fact table gives the latitude of the table model of the basic form and information on the storage and management of medical information directly related to the data. The latitude of the association table is the fact table. Table 1: Patient summary Data Management Project Fact table Latitude table Patient information management Medical affairs workers information management Patient information table Medical staff information table Medicine Medicine information Patient registration latitude table, medical records table, etc. Medical information form, nurses information table, information table carers, etc. Pharmaceuticals entering the table, information management sheet Hospital business information management Hospital business information form splitting tables drugs, drug sub-delivered, drug inventory table, patients receive medication information form, etc. Out-patient service information table, emergency service information table, etc. There are many fields in the latitude table, and the fact table with a reasonable correlation, as shown in Figure 5. Patient registration table PatientID PatientName Sex Age Source Quantity Paytype DoctorID Diagnoses Result DrugID ... Figure 5. Patient information fact table. Detailed design and construction We take patient information as an example to explain the star model of the composition of the latitude model. The patient information management theme indicators as entities in the fact table of the star model include patientID, patientName, sex, and age indicators. The relevant latitude information then includes DoctorID, DoctorName, Sex, age, and SectionID, etc. The information constitutes the latitude entities in the star model shown in Figure 6. Fact tables and dimension tables set the connection so that each primary key of a dimension table is connected to foreign keys through the fact table. Doctor latitude table Patient registration table PatientID PatientName Sex Age Source Quantity Paytype DoctorID Diagnoses Result DrugID ... DoctorID DoctorName Sex Age SectionID Title Specialty ... Drug table DrugID DrugName Supplier Cost Stock ... Hospital section table SectionID SectionName Number Tel ... Figure 6. The star model for part of the theme of information management. The current database system for analysis, data design and obtaining source data changes is used to ensure the data warehouse has parallel source data systems. The main consideration in the design of the fact table is the selection of theme metrics, such as treatment costs and patient care activities, thus determining the key links with the dimension table. Analysis services of data warehouse The data warehouse as a platform for online analytical processing is a comprehensive technology that involves using Structured Query Language (SQL) integrated functions, multi-dimensional analysis techniques applied to design comprehensive analysis, and procedures for the preparation of a series of SQL search issues and technology. On the basis of the above data warehouse, the analysis services of the data warehouse are created as follows. (1) Establish a connection: Create Open Database Connectivity (ODBC) using a Microsoft SQL Analysis server data source connection; i.e., the Microsoft SQL Server connection. (2) Design the data model: The hospital information system can be divided into the hospital management information system and clinical information system according to theme. The hospital information system includes the hospital information management subsystem, personnel management information subsystem, and pharmacy management information system. Identify the themes and domain, thus creating a dimension table. Most dimensions of the data warehouse of the analysis server are built into a shared dimension; e.g., the time, doctor, and patient cube, other dimensions as non-shared dimensions. (3) Create a cube: A cube is an online analytical process in which a data warehouse quickly accesses technical data. Once a cube is created, a dataset that matches the object of sustainable access is created through the analysis manager of the browse data option to view a multi-dimensional set or query the database to obtain large quantities of data. (4) Collation of datasets based on the above model: The basic information includes the patient, the payment schedule, outpatient form a cube, and the cube-patient pose. Online analytical processing (OLAP) and a data warehouse are inextricably linked although they are based on different concepts. The data warehouse for a hospital is a large-scale database of historical data, which are mainly used for business analysis and to support decision making. These data cannot be used in the transaction processing system directly. The design mode of the OLAP model based on the data warehouse is shown in Figure 7. Client A Data source 1 Data source 2 Data warehouse Visualization Multidimensional treatment Data source … OLAP server Establish a connection Figure 7. Design the data model Create a cube Client B Client … Collation of data sets The design mode of the OLAP model based on the data warehouse. RESULTS The establishment of a hospital information system provides the information bus for summarizing medical data, storage, analysis, management, and information sharing to provide data exchange. Information on medical and health services must be kept in the data center, as a basis for future decision making. A number of distributed hospitals or different departments in a single hospital may provide medical services to patients and share resources, such as in the case of data sharing among hospitals, resource coordination, and service sharing; the hospital would have a central database, or each department would have its internal local database. Data warehouse technology has become a potential solution to the problem of integrating data from different sources. This paper proposed a design method for a data warehouse to build a hospital information system and share the regional coordination of medical services. DISCUSSION A hospital information system based on data warehouse effectively uses a management information system with statistical analysis and data mining technology to handle massive quantities of historical data, to summarize new knowledge of clinical and hospital management, and to provide support for scientific decision making. Data warehouse technology is continually evolving. We need a data warehouse based on medical information for further in-depth study that will allow hospitals to provide increasingly valuable decision-support information, including information on disease control and diagnosis and treatment, information on hospital management, and information to promote hospital services, such as regional medical services. A consortium that shares medical resources could thus be realized. References 1. 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