1. April 7, 2005Baltic IT&T 2005 Forum1 Hopes And Constraints Concerning Hospital Information System Dzintars Mozgis, Dr.med Chairman, Board, University Hospital for Children, Riga, Latvia Vladimirs Strazdins, MD Head, Nephrology, University Hospital for Children, Riga, Latvia

2. April 7, 2005Baltic IT&T 2005 Forum2 Initial Expectations Our cultural and historical tradition is neither the best, nor the worst, but it surely determines the reality Our cultural and historical tradition is neither the best, nor the worst, but it surely determines the reality We expected (and quick) to create the electronic patient management system able to cope with: We expected (and quick) to create the electronic patient management system able to cope with:  Patient registration & scheduling  Electronic medical records  Lab management  Pharmacy management  Medical billing  Long-term care  Medical practice management, etc.

3. April 7, 2005Baltic IT&T 2005 Forum3 Harsh Reality We were wrong! We were wrong! Though with big efforts and a long time, but fortunately not investing the big money we have completed only the first step (registration) by now Though with big efforts and a long time, but fortunately not investing the big money we have completed only the first step (registration) by now By constantly putting in the extensive personal efforts, time and enthusiasm we currently may probably be in the middle of completion of the next three to four steps By constantly putting in the extensive personal efforts, time and enthusiasm we currently may probably be in the middle of completion of the next three to four steps  Patient scheduling – on the way  Lab management – on the way  Pharmacy management - on the way  Electronic medical records - slowly developing

4. April 7, 2005Baltic IT&T 2005 Forum4 Main IS Principles From the IT point of view the clinical (medical) workstation is an interface between the computer network and medical, patient care, and administrative processes From the IT point of view the clinical (medical) workstation is an interface between the computer network and medical, patient care, and administrative processes While developing the concept of our hospital IS we decided it should provide our staff with the maximally simple (operated on the intuitive level) easily accessible data base with only basic data processing While developing the concept of our hospital IS we decided it should provide our staff with the maximally simple (operated on the intuitive level) easily accessible data base with only basic data processing The user should not even be aware of the database structure, operating system involved, or other technicalities The user should not even be aware of the database structure, operating system involved, or other technicalities

5. April 7, 2005Baltic IT&T 2005 Forum5 Decision-making Policy Evidence-based and cost-effective treatment requires the correct account of the expense involved, and the quality management needs the comprehensive integration of the related information Evidence-based and cost-effective treatment requires the correct account of the expense involved, and the quality management needs the comprehensive integration of the related information Only then the particular therapeutic or diagnostic issue analysis will become possible, and as a result the proven concepts of therapy, guidelines, and protocols will develop Only then the particular therapeutic or diagnostic issue analysis will become possible, and as a result the proven concepts of therapy, guidelines, and protocols will develop It is essential not to base those end products on the single person’s (doctor’s) opinion like traditionally done in previous years, but to make those solidly based on proven results and teamwork analysis of the quality and other parameters achieved It is essential not to base those end products on the single person’s (doctor’s) opinion like traditionally done in previous years, but to make those solidly based on proven results and teamwork analysis of the quality and other parameters achieved

6. April 7, 2005Baltic IT&T 2005 Forum6 Do Not Expect Wonders It is wrong to expect the hospital IS to raise the productivity by itself It is wrong to expect the hospital IS to raise the productivity by itself Though both hardware and software costs are dropping, the hospital IS at least initially looks more like a bottomless cavity, where you can dump the investments with actually no limits Though both hardware and software costs are dropping, the hospital IS at least initially looks more like a bottomless cavity, where you can dump the investments with actually no limits The initial phase usually results even in productivity decline due to learning processes, especially for those with low or absent PC user skills, who are usually afraid of using the IT The initial phase usually results even in productivity decline due to learning processes, especially for those with low or absent PC user skills, who are usually afraid of using the IT

7. April 7, 2005Baltic IT&T 2005 Forum7 Limitations There are enormous data quantities in medicine There are enormous data quantities in medicine The usual attempt is to collect and to store all available data in all details, and for as long as possible The usual attempt is to collect and to store all available data in all details, and for as long as possible The above concept is completely wrong, since no technical resources are available to store the data and make those available in a few seconds time The above concept is completely wrong, since no technical resources are available to store the data and make those available in a few seconds time Attempts to develop such a system end up with a mighty expensive data graveyard! Attempts to develop such a system end up with a mighty expensive data graveyard!  Take your PC and look at what percentage of stored data you really use?

8. April 7, 2005Baltic IT&T 2005 Forum8 Priorities Therefore the most difficult and effort-consuming, but the mostly needed task is to define the priorities Therefore the most difficult and effort-consuming, but the mostly needed task is to define the priorities  Exactly what information and to what extent will certainly be (but not might be) needed in a future The above determined our decision to avoid the most usual mistake to get everything available at once The above determined our decision to avoid the most usual mistake to get everything available at once We started to develop our hospital IS step by step, simultaneously learning and training ourselves We started to develop our hospital IS step by step, simultaneously learning and training ourselves  Only when one of the system components is ready, implemented, tested in daily routine and is well- accepted by end-users, we make the next step to start another module

9. April 7, 2005Baltic IT&T 2005 Forum9 Hospital IS Requirements Therefore, we concluded that the main requirements for hospital IS are Therefore, we concluded that the main requirements for hospital IS are  Low cost  High stability  High data security level  Minimal possibility of virus threat

10. April 7, 2005Baltic IT&T 2005 Forum10 Our Choice Hospital description Hospital description  600 pediatric beds in 23 specialized clinical departments (wards), supportive medical & non- medical units Workstations Workstations  40 Linux-based hospital IS workstations  110 Windows-based hospital general network workstations Servers: 4 firewall-protected (Hospital IS server, General file server, WWW server, and Mail server) Servers: 4 firewall-protected (Hospital IS server, General file server, WWW server, and Mail server) Connections: 100 mbps optical cable + 10 mbps UTP + 2 mbps Internet radio link Connections: 100 mbps optical cable + 10 mbps UTP + 2 mbps Internet radio link

11. April 7, 2005Baltic IT&T 2005 Forum11 Currently Implementing Direct data input from automated lab analyzers Direct data input from automated lab analyzers  All lab equipment already changed to automated stations with data output modules Pharmacy database connection to hospital IS Pharmacy database connection to hospital IS  Current database is separate and uses a different data format Outpatient clinic IS is under development from scratch Outpatient clinic IS is under development from scratch  Scheduling, registration, lab data input, medical records, etc.

12. April 7, 2005Baltic IT&T 2005 Forum12 Outside Connections The ability to link clinical data systems between institutions is becoming more important as our society continues to develop The ability to link clinical data systems between institutions is becoming more important as our society continues to develop Local area and distributed networks are the probable means of providing such a linkage Local area and distributed networks are the probable means of providing such a linkage Standardization of data format is crucial to facilitate the functionality of networks Standardization of data format is crucial to facilitate the functionality of networks Considering the possible data exchange with the primary care physicians we are cautious, since the most sophisticated and expensive IS will fail until the relations between those two levels will improve Considering the possible data exchange with the primary care physicians we are cautious, since the most sophisticated and expensive IS will fail until the relations between those two levels will improve It will take a long and intensive managing and psychological work to achieve the passable relations It will take a long and intensive managing and psychological work to achieve the passable relations