Web-Based Medical Records Design and Implementation at Columbia-Presbyterian Medical Center - PowerPoint PPT Presentation

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Web-Based Medical Records Design and Implementation at Columbia-Presbyterian Medical Center

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Title: Web-Based Medical Records Design and Implementation at Columbia-Presbyterian Medical Center


1
Web-Based Medical RecordsDesign and
Implementation atColumbia-Presbyterian Medical
Center
  • James J. Cimino, M.D.
  • Department of Medical Informatics
  • Columbia University

2
CPMC in 1988 - preTCP/IP
IBM Mainframe
Data Repository
Data Monitor
Vocabulary Server
Results Review
Ancillary Systems
Clinicians
3
Data Monitor - Input and Alerts
  • Stores all data in repository
  • Checks data for triggers
  • Executes Medical Logic Modules
  • Stores alerts in repository

4
Data Repository
  • Row-oriented relational database (DB2)
  • Event-oriented
  • Flexible and extensible
  • Clinical data coded with MED
  • Multiple time stamps

5
CPMC 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
6
Clinical Database Server - Output
  • Dynamic queries (SQL)
  • Canned queries
  • Time span
  • Last "n" results
  • Class-based retrievals ("get all positive
    culture results")

7
Medical Entities Dictionary (MED)
  • 56,000 medical concepts
  • 82,000 synonyms
  • Multiple hierarchy (72,000 links)
  • Semantic network (43,000 links)

8
MED Semantic Network
Tests
Findings
Chemicals
Medications
Calcium Preparations
Intravascular Calcium Tests
Abnormalities of Calcium
Calcium
Hypercalcemia
Hypocalcemia
Serum Calcium
Plasma Calcium
9
MED Server
  • Lexical searching
  • Concept attributes
  • Classes
  • Ancestors

10
CPMC in 1994 - WWW
IBM Mainframe
Data Repository
Data Monitor
Intranet
Minicomputer
Web Server
Internet
Internet
Vocabulary Server
Knowledge Resources
Clinicians
11
Web Server
  • Clinical database server queries
  • Vocabulary server queries
  • Class queries
  • Translation
  • HTML document generation
  • Applets
  • Web links

12
Web-Based EMR
IBM Mainframe
Data Repository
Data Monitor
Intranet
Minicomputer
Web Server
Vocabulary Server
Clinicians
13
CPMCs Web EMRs
  • Elpis - single patient view
  • PolyMed - service view
  • WebCIS - multiple views
  • PatCIS - for patients

14
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

15
Screen Shots of WebCIS
16
PatCIS
  • Data review
  • Data entry
  • Education
  • Advice
  • Infobuttons

17
PatCIS Architectural Features
  • Frame-based user interface
  • Buttons and "sub-buttons"
  • Single central CGI
  • security
  • usage logs
  • JavaScript functions to support application
    integration

18
PatCIS 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
19
Advantages 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

20
Screen Shots of PatCIS
21
Integration with On-Line Resources
Intranet
Minicomputer
Web Server
Internet
Internet
Vocabulary Server
Knowledge Resources
Clinicians
22
Integration through Terminology
2
5
4
Get Information From EMR
Automated Translation
Resource Terminology
6
1
Querying
Understand Information Needs
3
7
Resource Selection
Presentation
23
Infobuttons
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
24
Screen Shots of Infobuttons
25
Security and Confidentiality
  • User logon name and password
  • Encryption (SSL)
  • Logon screen ID (single use)
  • Session screen ID (expires)
  • Database access log

26
Current Challenges
  • Security
  • User ID management
  • No control over client machines
  • Application development
  • Navigation of hypertext
  • Resource integration
  • Evaluation

27
Ingredients for Success
  • Powerful, flexible back end
  • Repository
  • MED
  • HTML and HTTP
  • Web resources
  • People
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