Title: Web-Based Medical Records Design and Implementation at Columbia-Presbyterian Medical Center
1Web-Based Medical RecordsDesign and
Implementation atColumbia-Presbyterian Medical
Center
- James J. Cimino, M.D.
- Department of Medical Informatics
- Columbia University
2CPMC in 1988 - preTCP/IP
IBM Mainframe
Data Repository
Data Monitor
Vocabulary Server
Results Review
Ancillary Systems
Clinicians
3Data Monitor - Input and Alerts
- Stores all data in repository
- Checks data for triggers
- Executes Medical Logic Modules
- Stores alerts in repository
4Data Repository
- Row-oriented relational database (DB2)
- Event-oriented
- Flexible and extensible
- Clinical data coded with MED
- Multiple time stamps
5CPMC in 1991 - TCP/IP
IBM Mainframe
Data Repository
Data Monitor
Vocabulary Server
Results Review
Intranet
Minicomputer
Minicomputer
Upload Engine
Clinical Application
Vocabulary Server
Vocabulary Server
Ancillary Systems
Clinicians
6Clinical Database Server - Output
- Dynamic queries (SQL)
- Canned queries
- Time span
- Last "n" results
- Class-based retrievals ("get all positive
culture results")
7Medical Entities Dictionary (MED)
- 56,000 medical concepts
- 82,000 synonyms
- Multiple hierarchy (72,000 links)
- Semantic network (43,000 links)
8MED Semantic Network
Tests
Findings
Chemicals
Medications
Calcium Preparations
Intravascular Calcium Tests
Abnormalities of Calcium
Calcium
Hypercalcemia
Hypocalcemia
Serum Calcium
Plasma Calcium
9MED Server
- Lexical searching
- Concept attributes
- Classes
- Ancestors
10CPMC in 1994 - WWW
IBM Mainframe
Data Repository
Data Monitor
Intranet
Minicomputer
Web Server
Internet
Internet
Vocabulary Server
Knowledge Resources
Clinicians
11Web Server
- Clinical database server queries
- Vocabulary server queries
- Class queries
- Translation
- HTML document generation
- Applets
- Web links
12Web-Based EMR
IBM Mainframe
Data Repository
Data Monitor
Intranet
Minicomputer
Web Server
Vocabulary Server
Clinicians
13CPMCs Web EMRs
- Elpis - single patient view
- PolyMed - service view
- WebCIS - multiple views
- PatCIS - for patients
14Web EMR Features
- Frame-based interface
- Summary reporting
- Graphical displays
- Multimedia displays
- Cross-patient displays
- Order entry
- Integration of on-line resources
- Security and confidentiality
15Screen Shots of WebCIS
16PatCIS
- Data review
- Data entry
- Education
- Advice
- Infobuttons
17PatCIS Architectural Features
- Frame-based user interface
- Buttons and "sub-buttons"
- Single central CGI
- security
- usage logs
- JavaScript functions to support application
integration
18PatCIS Architecture
Web Server
Web Browser
2
patcis.cgi
3
4
Data Entry
Session Registry
Java Script
Vital Signs
Blood Sugar
Logout
5
Data Entry
Re-enter Password
1
6
Review
Advice
Education
Usage Log
CGI
Link
Comments
Help
7
8
9
10
11
JavaScript
CGI
Internet
19Advantages of PatCIS Design
- "Light" user interface
- Handles security for applications
- identification
- authentication
- authorization
- logout
- timeout
- Handles logging functions
- tracks usage
- records accesses to clinical database
- Maintains consistent look feel
20Screen Shots of PatCIS
21Integration with On-Line Resources
Intranet
Minicomputer
Web Server
Internet
Internet
Vocabulary Server
Knowledge Resources
Clinicians
22Integration through Terminology
2
5
4
Get Information From EMR
Automated Translation
Resource Terminology
6
1
Querying
Understand Information Needs
3
7
Resource Selection
Presentation
23Infobuttons
DXplain
Cholesterol Guideline
Laboratory Test Results
PDR
Dietary Interactions
Micromedex
Medication Orders
Medline
Clinical Info System
X-ray Reports
Radiol Museum of South Bank
Webpath
CHORUS
24Screen Shots of Infobuttons
25Security and Confidentiality
- User logon name and password
- Encryption (SSL)
- Logon screen ID (single use)
- Session screen ID (expires)
- Database access log
26Current Challenges
- Security
- User ID management
- No control over client machines
- Application development
- Navigation of hypertext
- Resource integration
- Evaluation
27Ingredients for Success
- Powerful, flexible back end
- Repository
- MED
- HTML and HTTP
- Web resources
- People