Increasingly, medical care is being provided in multiple settings and at multiple points, thus creating a need for clinicians to pool together the available clinical data and share it in order to provide a complete picture of an individual patient. The bricks-and-mortar hospital is no longer the central focus of care. The “solid” remnants of the monolith are now merely supports for the information management system that has become critical to holistic care. This system, and its management, becomes the “virtual” hospital/health system.
Put simply, Clinical Information Systems (CIS) are those information technology systems that are applied at the point of clinical care. These are healthcare information systems used by doctors, nurses and other healthcare providers to provide clinical care to patients.
Types of clinical information systems and applications
Some of the major Clinical Information Systems (CIS) are as follows:-
Ambulatory or Outpatient Clinical Information Systems including the Ambulatory/OPD Electronic Medical Record (EMR)
Inpatient Clinical Information Systems including the Inpatient Electronic Medical Record (EMR) and Computerised Provider Order Entry (CPOE) systems.
Speciality systems like the Emergency Department Information System, ICU Information System, Cardiology Information System, and Oncology Information System.
Ancillary Information Systems like Laboratory Information System, Pharmacy Information System and Radiology Information System
Briefly describing the systems above and how they work together:
Ambulatory/OPD Clinical Information Systems
Ambulatory/OPD information systems have two major parts which should be well integrated with each other. One part is the clinic administration and management system which include the Registration, Scheduling and Billing functionalities (referred together as the Practice Management system (PM)) and the other part is the actual ambulatory healthcare delivery system which is the Ambulatory EMR. These systems are tailored for the typical clinic visit workflow by a patient (termed as an “encounter”), which in summary is as follows (see Figure 1).
The patient is registered, an appointment with the doctor is scheduled, the patient arrives for the doctor’s appointment and is checked in, patient waits in the waiting room until called into the exam room by the nurse or appropriate support staff. The chief complaint, vitals and nursing notes are taken down by the nurse/support staff. The doctor then enters the exam room, reviews the case, goes on to note history and conduct a physical examination, then orders lab and other tests and prescribes medications. The patient may then proceed to the lab for giving sample for tests like blood or urine. The patient then moves on to the pharmacy, collects his/her medicines and then checks out after paying their bill. There could be minor variations in this workflow, for example a small procedure could be done in the exam room, but the general workflow is as mentioned above.
When we say an OPD clinic is paperless, besides replacing paper medical records, the EMR also replaces paper lab forms and paper prescriptions. The functions of ordering tests and medication are now done electronically by the EMR. Therefore, from the perspective of the doctors, nurses and healthcare providers, the Ambulatory EMR should have the following features to function as an effective electronic healthcare delivery system in the OPD clinic: