Research software system for electronic health records deployed in hospitals

The Ministry of Health has prescribed the software standard for hospital management software: The establishment, storage and authorization of electron[r]

Research software system for electronic health records deployed in hospitals

Group sciences: Đỗ Thị Tú Uyên

Nguyễn Thị Anh Thu Class: MIS016A

1 The necessary of topic

In the medical information system, especially the hospital information system, the storage of patient information, books and paperwork is very important, careful and consuming Large numbers of archival records, such as archives, are too time-consuming, difficult to find, especially information sharing between faculties or hospitals with patients is almost impossible In addition, when the patients go to the examination must bring old records, papers and medical records are very inconvenient and time consuming for doctors and medical staff to check the health status of the patient

In Vietnam, technology 4.0 is growing so the birth of electronic medical records is extremely urgent and practical It makes it easier to diagnose, statistics and scientifically research the specialty, reduce the annual storage of hospital records, and help patients and clinicians improve the effectiveness of the clinic treatment and health care for patients As a result, nowadays, hospitals in the country have gradually shifted to the collection and storage of electronic medical records

2 The goal of topic

Health care is a matter of concern in this day However, the annual cost for it is very large, especially in the management of records and keep the data is not a small number In addition, the manual management of medical records has many shortcomings in the storage, lookup, preservation and confidentiality of information This is a push for electronic medical records (EMR) to appear EMR makes it easier to store patient information, doctors and patients better understand the information

3 Research questions, methodology and scope of research  Research questions:

In general, we have followed a few key questions below to make this report:

- What is electronic medical records?

- What is situation of electronic medical records at home and abroad? - What are advantages and disadvantages of electronic medical records? - How difficult and how to overcome?

 Methodology:

Firstly, the research team studied many documents on the network of hospitals in the world such as China, Australia, USA to be able to get a better overview of the innovation and development of the medical Old medical records and the problems revolve around it The research team combines various methods such as integrated analysis, descriptive statistics, and so on, through the observations and experiences of each team member, to discuss the advantages and disadvantages of each Medical records with electronic medical records, causes - actual situation and solutions That is using the comparison method Through the research methodologies and surveyed sites, the research team can draw on the experience of paper medical records and how EMR can be put into operation, so that it can bring many benefits to the people, not expensive but modern and catch up the trend of the world

 Sphere of analysis:

Due to time constraints as well as busy learning, here we only mention electronic medical records in general and the situation in some hospitals in the North as a number overseas hospitals through the internet

4 Facilities and the difficulty of the researching process 4.1 Facilities

4.2 Difficulty

Firstly, the research time is limited and due to busy learning, the group cannot study deeply about the topic Secondly, the physical facilities for research are limited In addition, the group also had limited access to hospitals In other words, the scope of the research group is limited and mainly referred to through the media, television, internet, etc

Chapter 1: Overview of Electronic Medical Record and Paper 1.1: Paper medical file

1.1.1 Definition:

Under Clause 1, Article 59 of the Law on Examination and Treatment (No 40/2009 / QH12) passed by the 12th National Assembly of Vietnam on November 23, 2009, provides: "Medical records are medical documents legal and legal; Each patient has only one medical record at each medical examination and treatment at medical examination and treatment establishments " According to foreign sources, "dictionary.com" states: The medical record is "a written document of the length of the medical examination and treatment of a stroke, including a medical history and patient complaints., the clinical outcome of the doctor, the results of diagnostic tests and procedures, drugs and procedures

Medical records are treated as a brochure containing a variety of information and aspects of the patient From personal information such as name, date of birth, address, living situation, work, to illness, biography, From that, medical records can be viewed as There are two main types of patients: primary and secondary patients In particular, the main disease plays a role directly related to the patient's medical examination and treatment such as doctor's examination, diagnosis, tests, prescriptions, follow-up examination can also be considered as part of the main medical records However, it is closely related to the hospital, not patients such as personal information, health insurance, hospital fees, hospital admission procedures, patient support administrative

clinical management Accurate, accurate, systematic records will help to make the diagnosis, treatment, prevention, scientific research or training more effective It also helps to assess the quality of treatment, morale, responsibility and ability of health staff in particular and the hospital in general

1.1.2: Features

1.1.2.1: History of the formation

Decision No 4069/2001 / QD-BYT, September 28, 2001, of the Ministry of Health promulgating forms of dossiers for medical examination and treatment establishments (collectively referred to as hospitals) public, private, private, foreign-invested medical examination and treatment establishments Particularly leading specialized hospitals, due to intensive requirements, may add some necessary contents to the samples after obtaining the Health Minister's consent

1.1.2.2: Basic structure

There are 24 medical records for general hospitals Each type has its own structure but basically consists of the main parts such as:

• Medical records

The size is 27x53 cm The front of the cover shows the patient information as well as the type of illness and some information at the doctor's visit The back cover is medical records

• Documents and contents inside the medical record

Include a general information about the patient, the status of the examination, the administrative papers, the results of the test, the standard meeting card, treatment card, family guarantee, etc

• Summary of the medical records

The important thing is that all the papers inside the medical records must have the signature, title, and seal of the people involved in the disease Especially the primary physician

Figure 51: Diagram of the forming a generic medical record 1.1.3: Access to medical records

The question is: Who has the right to see the medical records?

• A medical record is the property of the hospital or the physician This is a confidential information of the patient and cannot be distributed without his or her permission

• All patients have access to their records and get copies of those records

• The legal representative of the patient has the right to such records as long as the patient has signed a notice with the request of the representative at law

• Other health care providers have the right to keep a record of the patient if they are directly involved in the care and treatment of the patient

• Parents of minors also have access to patient records

• Medical records are often called in court in some cases such as road traffic accidents, medical malpractice, insurance claims

1.1.4: Meaning of medical records

Due to the above characteristics, medical records have important and irreplaceable meanings These basic meanings are:

1.1.4.1: practical meanings

Because medical records have a direct relationship to human health, it has a great significance in the real world Some typical meanings are:

• Real patient monitoring • Medical research

• Medical education

• For insurance, personal injury, employee compensation, a criminal case, case • For litigation

• For medical audit and statistical research

In addition, medical records reflect the relationship between the physician and the patient during the course of treatment is recorded in the medical record The attitudes, behaviors, and satisfaction of patients with the hospital can be assessed

1.1.4.2: Historical-Scientific Meaning

Systematic records are very important and necessary materials to summarize and research scientific issues such as diseases, new treatments, new exploration methods, pathological characteristics A good medical record serves the interests of doctors as well as their patients It is very important that the treating doctor properly record the management of the patient under his or her care Thus, medical record keeping has evolved into the science

Domestic and international medicine has had different stages of development and development with the aim of becoming more complete Because of that, electronic medical records were born to overcome the limitations of traditional paper medicine In the era of science-technology development such as dancers, the electronic medical birth is inevitable and obey the laws of nature and society

Therefore, it can be reassured that medical records are extremely important and that no document can be replaced

1.1.5 Difficult of medical paper: 1.1.5.1 For hospital leaders:

- Incorrect information: Hospital management is dependent on information collected from functional departments, but this information is often delays, omissions, and misleading information Forms of paper reports, oral reports, meetings have many limitations on accuracy and reliability Reporting data is influenced by the sentiment and expertise of the reporter

- Inadequate information: The hospital's activities are now reflected in discrete, incomplete, interlinked reports Most of the reported data coming from different parts not match the figures when compared Therefore, the hospital leadership cannot fully supervise hospital operations

- Loss of assets, lack of financial transparency: Because each department manages a function of the hospital, there is no check, collate, verify immediately should occur the loss of property, loss Hospital fees, which are prominent groups of management fees, pharmaceuticals, public assets

Negative: Negative situations cannot be investigated by accidental or intentional employees

1.1.5.2 For hospital staff:

- Lack of human resources: Currently, Vietnam lacks human resources for health due to inadequate training Hospitals are always overloaded

- Human lack of professional quality: Due to busy in overload patients, doctors lose the ability to train themselves due to lack of time, lack of books The knowledge of doctors is always old compared to The world's information situation is constantly changing

Figure 52: Difficult of medical paper for hospital staffs

- Waste of storage and retrieval of medical data: Doctors cannot store patient records in a scientific way Most of the medical records are stored in paper, the contents of the recordings are insufficient Although medical records are stored, it is rarely exploited for scientific research

- Waste of information: When examining and treating patients, doctors cannot see the medical history accurately and accurately, especially the way the chronic disease Therefore, the assessment of the condition will lead to errors There is no memory facility, no library system available to support the work The doctor cannot remember everything, so there is a need for a memory system, a library in place for reference as needed This helps to improve the value of the doctor's work, which is beneficial to the patient Para clinical data such as tests; diagnostic imaging are not stored This is the data warehouse for scientific research

- Waste of time: While doing medical records, medical examination, doctors spend a lot of time writing on paper At each stage of the examination, patient information must be recorded repeatedly Patients with chronic illnesses who need multiple examinations should also record administrative details, which can take time

can harm patients because of the wrong medication or use the wrong way Prescriptions are not contraindicated; drug interactions will also harm the patient 1.1.5.3 For patients:

- Many troubles in medical examination and treatment: The cumbersome administrative procedures in patient registration make troublesome for patients The time to receive medical services is less than waiting time, loading due to administrative procedures such as registration, hospital fees, waiting for medicine

Figure 53: Difficult of medical paper for patients

Negative: When procedures are difficult for the patient, there is a negative relationship between the patient and the healthcare provider Victims, hooks occur in many places - Medical harm: Patients with special conditions such as allergies, pregnancy, lactation, children or special diseases should avoid using potentially harmful drugs As doctors lack information about the patient as well as lack of information about the drug, these patients are taking drugs that are contraindicated and harmful

synchronous manner for monitoring purposes Paper records make it difficult to carry the records and doctors not have much time to see the full course of the disease 1.1.5.4 For health reporting system - statistics - disease test:

- The hospital statistics used to report to the above management levels are not accurate and incomplete

- The manual reporting of the paper takes a lot of time

Figure 54: Difficult of medical paper for health reporting system statistics -disease test

(Internet photos)

- There are too many types of reports, statistics to do, repeat

- When epidemics arise, the data does not show immediately to have a treatment plan

1.1.5.5 For health insurance policies

The State of Vietnam is implementing the health insurance policy, moving towards universal health insurance by 2014 In the past years, the implementation of the health insurance law has caused many problems, so far has not been resolved decisive:

- The method of calculating the co-payment fee is complicated, making it difficult to calculate and determine the hospital fee for each patient

- Formulas for calculating health service packages that are not actually collected actually cause many difficulties for accountants

- The division of drug store into service stores and health insurance holdings increases the management of pharmaceuticals and difficulties in the supply of drugs

- Problems of child health insurance and accident cases are unclear

- Quarterly statement-making difficult, takes much time and effort of accounting personnel The reports are frequently deviated from the data, resulting in delinquent settlements, causing difficulties for hospital operations

- Health insurance reporting requirements change frequently, making it difficult to report data

- There is also the problem of abuse of health insurance card of patients and medical staff, deliberately misrepresentation to receive drug causing loss to the health insurance budget This has happened in many places and there are no effective preventive measures

- The troublesome administration of health insurance gives patients the difficulties of medical examination make the patient look aversion

1.2: Electronic Medical Record 1.2.1: Birth, definition

Medical records are attached to any person at every visit to health facilities But now, it has been replaced by "electronic medical records", meaning that all health information from birth to death is digitized Trends in many developed countries in the world have been applied in some hospitals in Vietnam, contributing to shortening the time of medical examination and treatment Medical records are also used by patients as a method to connect with the doctor The medical records have been amended and supplemented many times in historical periods to date, but such efforts have not yet been able to remove all the burdens that hospitals, administrators, doctors and patients face Therefore, electronic patients are born with the use and great role to meet the needs of social development today

includes the patient's demographic tracking functions, medical history, SOAP notes, used drugs, test results and more half

Electronic medical records (EMRs) are sometimes referred to as electronic health records (EHS) According to the generally accepted definition, HSI is the patient's medical history created and stored in a single database Meanwhile, HSBC is a complete collection of patient records that have been created and stored at various medical database sites Due to the technical differences between the two concepts 1.2.2 Overview of utility, properties of electronic medical records

The following are the minimum benefits provided by the software after successful implementation:

• Improve the effectiveness of medical practice

Treatment management and treatment will be rationalized at the highest level Indeed, cumbersome paperwork is eliminated, leaving doctors more time to focus on patient care The speed of treatment of treatment regimens will be faster due to the fact that the medical information is retrieved and accessed conveniently The process of delivering and receiving test results from departments and prescribing electronic drugs will be automated with accuracy and speed significantly higher

• Spend more time with the patient

As physicians are freed from a variety of paperwork-related jobs, they spend more time-saving visits and medical examinations for more patients Cardiology also allows doctors to complete medical records faster, thus further increasing the probability of seeing more patients

• Increase sales of medical practice

Electronic medical records (blood samples, test results, disease codes .) automatically provide physicians with necessary information to complete the procedures for the payment of health insurance to insurance companies E-M code identification (E & M Coding) allows hospital accountants to make billing statements more accurately As the speed and quality of work improve, the number of visits will increase, and the revenue from health care will increase This is one of the top benefits of electronic medical records

Features include a drug database (prescription management, drug, and warehouse inventory), clinical symptom checkup, and drug interactions check those help doctors prescribe the right medication and correct medications amount The EBSS software also provides suggestions and solutions for clinicians based on clinical information (symptoms, patient illness history, etc.), or risk factors related to HR The patient's diet This is one of the remarkable advantages of electronic health records 1.2.3: Technology with Electronic Medical Record

Electronic medical treatment is a process of continuous struggle, persistence, difficulty, have to invest many resources Therefore, information technology is indispensable In the current technology 4.0, the birth of electronic medical records is an inevitable trend and consistent with the era With the presence of technology, electronic medical records have become more and more useful for users such as:

• Standardization of the general list currently used in e-medical software under the Ministry of Health and the competent authorities;

• Apply national and international standards to ensure interconnection, exchange of data between LIS and HIS software and testing facilities and equipment;

• Apply HL7 and DICOM standards to ensure interoperability, exchange of diagnostic data between RIS / PACS with HIS software and imaging equipment

• HIS, LIS, RIS / PACS software provides complete data/information for EMR software (HL7 CDA, Clinical Documentation Architecture (HL7 CDA)) interconnect, exchange clinical data with other medical software

With the characteristics listed above, we can imagine how the power of 4.0 technology has helped the health sector in particular and other areas of society in general

1.2.3: Factors that an electronic medical record must have:

General registration function for all patient information: Data collection is considered the key to successful HIS design Key components of the registration system:

Patient data from birth to death Maintaining data from start to finish

Character data, images, sounds, signals, digital data

when stakeholders can be comparable Directly interact with information on the system Important attributes are:

• Online access (online) • Supports endpoints

• Support doctors in the clinic

• Outpatient clinical information support

• Extract information, and support wireless devices

Recognizing that healthcare providers are primary users, applications must be easy to use The need for data sharing and functionality among healthcare providers is a driving force behind the need to integrate information across the system to improve the efficiency of HIS Key features include:

A user interface should be simple, easy to use • Functions must be complete

• Provides a variety of information retrieval methods on the system • Access to other data facilities

• Provide expert systems

• Provide data conversion tools to information • HIS must be cost-effective

• Open system design

• Use international standards • Design effective

• Design by modules

• Leverage available hardware and software

• Provide communication between the hospital and HIS systems: Provide standard procedures for healthcare professionals Provides procedures related to patient care operations, processing of information and data in medical records

• Use technologies that fully meet user needs and communication between other applications on the system: The overall solution to the information infrastructure, data formats must be modified / updated to suit the purpose and comply with international standards (such as HL7)

• Ensure attributes such as:

1) ability to respond, respond quickly, 2) High availability and reliability,

3) Confidentiality and integrity of data/information

The suggested general architecture of HIS HIS includes child information systems that cover all activities and streams of information about hospital management and treatment And also because of the size and size of the HIS, it is important to consider splitting the HIS system into independent and supportive subsystems to facilitate the development and deployment of HIS Sy

1.2.4: Conditions for implementing an electronic medical record: • Having an intranet;

• Having an operating electronic medical record server; • Have a database server (database) to store the records; There are workstations at each department or department; • Have IT, staff;

• Employees involved in electronic medical records must be skilled • IT capabilities;

• Have a system of safety, security and data confidentiality; stem

Chapter 3

The Emergence of Electronic Medical Record and how it works, its role. 3.1 Situation at home and abroad

Unlike our country, friends in Europe have had and deployed electronic medical records for a long time, and now it is as stormy The world has a significant growth rate (> 16%) of spending on health care, which is also a great potential for promoting e-commerce development According to a survey in 2008 of 4484 doctors in the New England Journal, less than 20% of those doctors used any kind of medical record The remaining 80% are "bought" but not used Although no country is 100% complete and perfect, developed countries are considered to be the best These are Australia, Canada, Estonia, Denmark, Finland, the Netherlands, Sweden and the United Arab Emirates

3.2: Parts of an electronic medical record and their concepts:

An electronic medical record consists of a number of different usages and functions, however, in here, we only focus on a number of data standards Let's take a look at some of the important data standards used in it

 HIS

Figure 55: Function of HIS  EMR

Electronic Medical Record: Electronic Medical Records Patient medical records are stored digitally

 DICOM - Define:

According to medical-dictionary, DICOM abbreviation for Digital Imaging and Communications in Medicine, a joint standard of the American College of Radiology and National Equipment Manufacturers Association; specifies entities (or objects) and functions (or services) to allow communication between various image sources and other computer devices, such as archives or workstations

- Function:

The DICOM standard allows for easy integration of image receivers, servers, workstations, printers, and other hardware devices that are networked from different manufacturers into the PACS system Different devices come with a table that meets DICOM standards to clarify the service classes that this device supports DICOM has been widely accepted in hospitals and clinics

 HL7

According to nanosoft.vn, the name HL7 is derived from the communication model of ISO Each layer has a role in which Layer to Layer refers to communications, including Physical, Datalinks, Network, and Transport Grades 5-7 refer to functions such as Session, Presentation and Application Layer is the highest class that refers to the application level including the concepts of data exchange This level supports a variety of functions such as security checks, participant identification, data exchange structures, etc

- Function

For the management of non-visual data, HL7 provides methods for the exchange, management and integration of diagnostic or managed electronic health data Health Levels is a non-profit organization established in 1987 that is recognized as the world standard for the exchange, integration, sharing and access of electronic medical information in hospitals as well as health organizations

HL7 creates "interoperability between electronic patient management systems, clinical management systems, laboratory information systems, cafeterias, pharmacies, accounting departments as well as record systems electronic health record (HER) and electronic medical record (EMR) system HL7 can be provided for free but the license is quite strict

 LIS

Laboratory Informatics System: laboratory information management system This system is responsible for receiving designation and returning the designation Testing information can be directly tapped from the test machine into the information management system Direct linkage testing can be either 1-way or 2-way One-way connection is the direct result from the test machine to the computer Two-way communication is to send patient information (PID) from the computer to the test machine and vice versa, receiving the results from the test machine to the computer  RIS

 PACS

- Define:

Picture Achieving Communicating System: As the development of the imaging industry grows, 3D medical image generation (DICOM standard) is emerging that requires a management and imaging system

PACS: A system for receiving, storing, processing and transmitting multimedia medical data to improve the efficiency of medical examination and treatment Military Medical Academy: "PACS is used for safe and economical image data archiving; Image data transmission facilitates remote diagnostics, diagnosis, treatment, training and research, and extends remote viewing and reporting capabilities " Wikipedia: "PACS is a medical imaging technology that provides economical storage of, and convenient access to, images from multiple modalities (source machine types)."

- PERFECT FUNCTIONS:

• Management of diagnostic imaging services: procedures for diagnosis, insurance, hospital fees

• Acquisition, organization of medical multimedia data storage: X-ray, CT, ultrasound, video surgery

• Provides diagnostic functions

• Provides photo-conferencing functionality: between faculty in the hospital and external clinics

• Provides video streaming functionality

• Provide ultrasound and endoscopic management program 3.3: Operating Procedures of Electronic Medical Records:

Figure 56: A general operational model of an electronic medical record

Step 1: Patient is registered at the hospital's reception room and staff is updated with administrative information for the patient

Step 2: Patient is directed to the clinic by the receptionist

Step 3: Patient will be examined by doctor and laboratory, laboratory Next, the patient pays a temporary fee and performs a Para clinical indication Then the patient will have the results

Step 4: Patient will return to the clinic, with subclinical results, the doctor will diagnose the disease and give the prescription

Step 5: The patient will be paid for the last time at the toll booth, next to the dispensary and finally to the reception room to receive login information on the hospital portal system to review the disease and the results of their diagnosis before returning home • Electronic medical records review, online consultation

Step 1: Patients log on to the hospital's web site

Step 2: Go to: Electronic Medical Records and view your results at the hospital portal View medical records: test results, endoscopy, ultrasound, electrocardiogram together with the medication used and the process of treatment, health care of themselves at the hospital

Patients may reprint or back up medical records about personal computers for medical proof or reference purposes

3.3.1: Collection and processing of input data 3.3.1.1: Build the database

• Purpose

In the design of the hospital information system (HIS), HIS must be scalable and able to integrate and communicate with external systems as well as internal hospital systems The main functions of an HIS must be able to integrate with other applications in the hospital such as patient information systems, patient information management systems, and financial management systems In addition, HIS must has a central database system that connects all hospital departmental information systems to store and provide information or data for all Information systems in the hospital In the hospital environment, the central database system supports a variety of purposes such as medical management, human resources management, patient management, and so on Because the database center serves multiple purposes and services, the database must be thoroughly detailed

• Types:

Includes two types of data (medical data, and patient management data)

Medical data is data related to the patient's disease status, clinical diagnostic data, laboratory and laboratory outcomes, and patient records; Patient ID data: patient identification information such as patient name, date of birth, sex, place of birth, ethnicity, etc Patient data of the patient: information This can be changed throughout the life of the patient such as the address of the place of residence, work, marital status, etc Medical examination data: Referral information for a hospital visit, such as ID the amount of medical examination and treatment, the kind of examination and treatment the patient's financial information including information on medical expenses, clinical examination costs, etc.)

operate the hospital's daily operations Incorporating these two types of data will increase the efficiency of hospital operations and management, and leaders use this information to plan future hospital developments

• Database management software

The Ministry of Health has prescribed the software standard for hospital management software: The establishment, storage and authorization of electronic medical records must comply with the provisions of Article 59 of the Law on Examination and Treatment; Ensure that data / information on patient status is recorded in electronic records should be in accordance with HL7 standards and in accordance with the regulations of the Ministry of Health; Make sure medical image data / information is compliant with DICOM format; Organizations and individuals permitted to use digital signatures and digital signature certification under the Law on E-Transactions dated November 29, 2005 on digital signatures and digital signature certification for electronic medical records; The provision and sharing of information in e-medical records must ensure the right to respect the privacy of patients as stipulated in Article of the Law on Examination and Treatment and regulations on filing medical records of the Ministry of Health; Electronic medical records must have the function of producing summary reports on the medical records when patients have written requests as prescribed in Article 11 of the Law on Examination and Treatment 3.3.1.2: Database Input:

With information about patients such as: name, sex, date of birth, ID number, code Automatically calculates the age in years for adults and calculates the child's monthly age Record contact information: address, email, phone, agency Patient information is entered only once in the receiving module Functional units such as the clinic, ultrasound, test will not need to re-enter the patient administrative information

Figure 57: Example of Database Input in EMR

Figure 58: Intermediaries and interfaces of HIS with other systems

The hospital electronic patient records system serves as a practical management system, such as prescription drugs, and medical billing applications The system also provides a user interface that interacts with data stored in a centralized database Centralized database servers are designed and implemented according to the functions of storing and retrieving patient data, clinical CDR Centralized database servers include primary and backup servers In case of major server failure or inactivity, the backup servers will be switched to main server mode to ensure continuous connection and operation

Users (doctors or nurses) can use their laptops or notebooks, or workstations, or handheld devices connected to the electronic medical records system over the intranet or the internet In design, workstations are equipped with web browsers or sub-machine software, all dependent on central servers for operational processes, and are primarily focused on data Input and output between the user and the remote server Some functions that hospitals, doctors can access online such as:

Figure 59: doctors can access online

Figure 60: Doctors can easily manage patients undergoing treatment 1

Figure 62: Typical Hospital IT Systems

In general, LIS-HIS-PACS are separate software but hospitals are required to have a complete electronic medical record system

Figure 63: The list of patients in system

Clinicians will use HL7 standardized HIS to transfer patients through RIS to assign necessary human resources (Reception, decision support, accounting, inventory) RIS also through HL7 pushes patients into empty equipment These devices perform tasks such as XQ, CT, RIR (DICOM STANDARD) or SUPERSONIC (non-DICOM)

Figure 65: The relationship of RIS and PACS

RIS and PACS have an intimate relationship with the two functions Reporting and Acquisition These two functions help to link two operations of the two sets And standing between RIS and PACS is Archiving

Next, the PACS (Diagnostic Viewing, Processing, Remote Viewing) will be the storage location, the diagnostic tool, the pediatrician reading the result, and then returning to HIS

Figure 66: Subclinical information for a patient

However, HIS only saves the result, not saving the image In contrast, DICOM includes both information and images Then he looked back at the PACS picture

Figure 67: PACS system

How DICOM and HL7 work to transfer information between electronic medical records? We will consider the following information:

• DICOM file format:

In general, an average of 20Mb of XQ, CT and XT is 100Mb-4Gb

header files are required for all DICOM files These data elements are labeled as (0002, xxxx), encoded by the hidden VR and Little Endian transformation syntax

Figure 68: DICOM file format

Figure 18 shows the DICOM format, including the first 794 bytes used to format the DICOM header, describing the image size and image information To know the image size, we rely on the information of Frames, Rows and Columns in the Header The image above is an example of an MRI with the number of Frames, Rows, Columns, respectively taken: 109 x 91 x = 19838 bytes So we will calculate the size of the image

Data Sets: Each file contains only one dataset that represents a specific SOP and is unique in relation to a single SOP and IOD layer A file can contain multiple images when the IOD is defined to carry multiple frames The conversion syntax is used to encode unique data sets through the UID syntax in the DICOM header file

DICOM file management information

The DICOM file format does not include file management information to avoid overlap with the related functionality in the intermediate format layer If necessary with a given DICOM application profile, the following information will be given to an intermediate format class:

- Identify file ownership

- Access information (date and time) - Access control of application files

Safe DICOM File Format: A secure DICOM file is a DICOM encrypted file with a cryptographic message syntax as defined in RFC2630 Depending on the encryption algorithm used, a secure DICOM file may have the following security attributes: - Data security

- Confirm the origin of the data - Data integrity

• The structure of an HL7 message The components of a message

HL7 has an information-driven structure, in contrast to the Server-Client-oriented architecture That is, when an event occurs, the application sends a message to the other application instead of responding to the request In that structure

Initial data → Block → Message → Message

- Primitive data: The data of a field or subfield For example, the Family Name field has the data Slater

- Composite: The block is made up of the original data or other volumes

- Segment: Each line in an information is assigned a message A message is made up of blocks Each paragraph contains a certain type of information For example:

The MSH message contains information about the sender, recipient, message type, time

+ PID information contains patient information such as name, ID, date of birth, gender

+ PV1 information contains information about the patients collected at the hospital: prevention, doctor’s treatment

Message: The HL7 message is an ASCII message, which requires that it be "readable" (i.e., if you ignore special characters, you can still read the information) Each message is a string or a group of messages Each message can be optional or repeated

The separator

The delimiters are an important part of the HL7 message, which is used to distinguish data fields, volumes, and so on

Character Purpose

0x0D Mark the end of a message

| Field Separation

& Sub-subfield subdivision

~ Separate repeating fields

\ Ignore character

3.3.3: Export outputs and medical record keeping 3.3.3.1: Output

3.3.3.1.1: Receipt - charge - Health insurance:

• Reception function helps to record patient identification information such as name, age and sex Record information at each visit as the destination, frontal diagnosis Classification of patients

• Charge function: depending on the type of patient, the charging method is different This is important because the way health insurance is charged varies from person to person

• Health Check Function: After each visit, the software will check the validity of the health insurance and save the billing information to make the health insurance report • Software that converts objects to solve problems for forgotten cards or expired cards Here is an example of hospital fees:

Figure 69: hospital fees

checked in the system and distributed to the patient This has made the procedure quicker and less error-prone than the labeling of the drug

3.3.3.1.2: Clinic module:

• Patient waiting list: Patients who register for a clinic will name the patient on the waiting list of the clinic

• Function of birth registration, history of illness, special conditions such as pregnancy, breastfeeding, diabetes as a basis for prescription drug safety

• Function of examination and recording of symptoms

• Sign function, Para clinical indication This function allows the BS to complete a command quickly He knows the price of a voucher to customize for each patient • Prescription function: Prescription drugs are automated on prescription, drug screening, drug interactions, drug interactions, contraindications in special cases • Other management: referral to another specialty, referral, hospitalization, counseling, examination

3.3.3.1.3: Image Diagnostics Subsystem:

• Today's medical facilities offer a variety of diagnostic images, such as radiography, endoscopy, ultrasound, CT MRI

• These devices feature medical imaging in DICOM and NON-DICOM formats These images are stored in patient profiles and are easily tracked by patient code or diagnostic code

3.3.3.4 Laboratory module:

• The test module records the results of the tests and automatically enrolls them into the patient records Test results are abnormal data

• All new testers have the ability to output test results to a computer The software system automatically imports the results from the test machine into the patient records 3.3.3.1.5: Outpatient Pharmacy:

• The function of drug import, drug pricing, drug delivery is designed many options depending on the management model of the hospital

• The outpatient health insurance used to distribute drugs to health insurance holders has a close relationship with the health insurance module, only after the approval 3.3.3.1.6: Residential management module:

• Hospital admittance management function: Revise the patient cover sheet The information on hospitalization, discharge, transfer, treatment results are saved to the data for the reports according to each criterion

• Medical record and medical records: The doctor records medical records and hospitalizations daily in the software, equivalent to the medical records

• Service management functions: Every patient admitted to the hospital has access to medical services

• Functional resident management: This is a complex system Prescription drugs will be synthesized and transferred to pharmacies; Importing drugs from drug stores to patients for re-distribution

3.3.3.1.7: Hospital pharmacy management system

• Drug storage system: including the warehouse with the function of purchasing and distributing drugs for retail stores; Retail stores are classified as drug stockpiles

• Inpatient drug system: used to synthesize drug requirements, sent to the warehouse, received medicine and distributed to the patient

• Cabinets: At the emergency department, the ward has a wardrobe to manage the medication needed immediately

• Medical and biological materials management system: to manage medical supplies, oxygen, hematologic, chemical

Figure 70: Medicine management for a patient 3.3.3.1.8 Reporting - statistics - data mining

• All departmental data is recorded and exported into national standardized reporting systems, into separate hospital records

• Data systems of software will become invaluable resources for statistics, secondary research

3.3.3.2: Storage and Preservation:

The department wants patients to be discharged from the hospital must send a request to the Department of Science and Technology

The STI will check the patient's medical records before accepting the patient's discharge After the release of the electronic medical records, the medical records will be automatically transferred to the General Plan and without the permission of the general planning department, the medical records cannot be opened

3.3.3.3: Situation of collecting electronic medical records into archives

Medical records are medical, medical and legal documents; Each patient has only one medical record at each medical examination and treatment at medical examination and treatment establishments

And collecting the lake

Electronic medical records in the store also have specific regulations: • Submitters of documents:

Medical records of inpatients, outpatients, referral and death must be completed administrative procedures according to the regulations into the hospital transferred, transferred to the hospital, then transferred to the department of general plan archive regulations Even this is also software automation

• Electronic records filed:

Medical records are automatically integrated into the machine so that records of inpatient, outpatient, referral and death records are automatically transferred to the General Plan room for preservation of the discharge order

• Time to deposit:

The patient is discharged within 24 hours, the department must complete the administrative procedures of the medical records according to regulations, transferred to the general planning department The General Planning Department checks the implementation of the regulations on medical records of the Directorate for approval and transfer of archives It's about regulation

But now in the hospital due to software applications should complete the medical records quickly in a few seconds When prompted to discharge from hospital, the electronic medical records were transferred to the General Planning Department The head nurse then submitted the medical records and sent them to the General Planning Department to complete the payment procedures records

• Application procedures:

and transfer of archives This stage of regulations is so, but in practice due to busy work from the director to retreat period about days (As in Vietnam-Soviet Friendship Hospital) It means that the General Planning Office must check the formalities of the file in accordance with the regulations or not If the patient's medical records have not been recorded in accordance with the regulations, the administrative nurse's requirements will be fulfilled

3.3: Advantages and Disadvantages of Electronic Diseases 3.3.1: Advantages

The growth of information technology today has created a solid foundation for the development of a complete electronic medical records system In recent years, many effective clinical systems have been put into use Clinical systems associated with electronic medical records have a lot in common It can be seen first of all that they maintain a very large data dictionary to define the contents of electronic medical records In addition, all patient records recorded in electronic medical records are linked to the time taken to make them based on the history of the care process These electronic medical record and data retrieval systems work in a flexible way, offering a research tool that uses electronic medical record data

Many difficulties, hindrance to previous technology for the development of electronic medical records now seem to have disappeared or been resolved However, although there is no need for a technological breakthrough, it is the growth of new technology products such as laptops, voice recognition, handwriting recognition, etc necessary to build a complete electronic medical record Many technologies have had to be tested in real-world situations; and many of them have proven to be beneficial in other areas, but not in the healthcare sector

In general, if you compare only the conventional cardiovascular disease, you will notice some differences as follows:

Medical records paper Electronic medical records Difficult to access parts of the

geographic distribution profile

Access privilege, at the same time

Passive: cannot start the action Active: can initiate certain actions depending on the data Presentation of non-normative

information standardized, more clear; It allows forInformation storage is more interlinking between departmental systems and can lead to improvements

in quality assurance

Type link "manual" "Expand" links with external health care providers

The risk of lack of information is greater (less check on full completion

information)

Can increase the completeness by checking additional structures when

entering data Presentation of data is not flexible

(only a single representation) multiple "angles" to meet needs (on anFlexible presentation of data across individual / patient basis or as a

whole) Spend plenty of time researching

financial or medical research

An excellent foundation for managing and directing financial and medical

research

There is no risk of technical failures The risk of technical failure and non-use is dependent on the substance

hardware / software Lower cost (only the initial cost is not

the full cost)

Higher costs for installation, staff training and system management Doctors manually enter data manually There may be resistance and anxiety

among doctors for entering data into the computer

Confidentiality; easy to access Difficult to maintain security and reliability (tracking and logging) Difficult to access parts of the

Passive: cannot start the action Active: can initiate certain actions depending on the data Presentation of non-normative

information

Information storage is more standardized, more clear; It allows for

interlinking between departmental systems and can lead to improvements

in quality assurance

Type link "manual" "Expand" links with external health care providers

The risk of lack of information is greater (less check on full completion

information)

Can increase the completeness by checking additional structures when

entering data Presentation of data is not flexible

(only a single representation) multiple "angles" to meet needs (on anFlexible presentation of data across individual / patient basis or as a

whole) Spend plenty of time researching

financial or medical research

An excellent foundation for managing and directing financial and

medical research

There is no risk of technical failures The risk of technical and non-technical failures depends on the quality of the

hardware / software

Lower cost (only the initial cost is not

the full cost) Higher costs for installation, stafftraining and system management Doctors manually enter data manually There may be resistance and anxiety

among doctors for entering data into the computer

Confidentiality; easy to access Difficult to maintain security and reliability (tracking and logging) 3.3.2: Limitations

 Technology:

• Medical data is large, transmission speed is high, accurate and no interference • Many systems exist

• There is no uniform standard of communication between hospitals

• Medical technology is growing rapidly  People:

• Familiarize the old process, afraid to change • Not used to computers, afraid to study

• Health workers are very busy so it is very difficult to get information, collect information

• For unstable requirements

• Information technology workers rarely cooperate: avoid responsibility, avoid additional work

• Opposition to competition • Change the process

• Change of receipt  Society:

• Changes in the health law, health insurance

• Changing the rules of personnel management, salary • Changes to the health information system

Chapter 4

Comprehensive Solution and Enhance Efficiency

in the Storage and Management of Electronic Medical Record.

In order to diagnose the patient, we must use a lot of information on medical history, diagnosis results, diagnostic information, visual information (X-rays, CT, MRI, .), even Databanks contain knowledge that supports the decision-making process Based on the application of electronic medical records, we still have difficulties that most hospitals still cannot solve

This chapter we have studied and studied the materials to make the best practical solutions for electronic medical records

Technical options:

With the equipment and modern equipment has given the hospital a number of problems that need information technology to solve it is:

- How can we store all the information, patient records, medical images from the machine in a scientific way? The purpose is to be able to build a medical data bank for data mining, diagnosis, treatment and study and research for physicians It is also part of an important legal record of retrieving information

- Standardization of data according to a common standard Build the system to easily exchange information, images, data between medical devices in the department To bring comfort and accuracy to the doctor in the diagnosis and treatment of disease quickly and effectively

- How to exchange data through the Internet for remote consultation

How to share information, medical data between hospitals in the area Serving for directing the line, reducing patient load from lower level hospitals

Applicable technical standards

The information system supporting medical diagnosis is developed in the direction of: - Medical management standards in the world: ICD, HL7, HIS, RIS, ERC, DICOM - The medical report forms system of the Ministry of Health of Vietnam

Accessories are made to ensure that they are in good working order and good performance in 3-5 years However, to improve performance and data security, we offer the following solutions:

Increase the application/database server ram capacity from to 16 GB

• Classroom equipment (2 servers running in parallel) for increased data security • Ensure stable operation 24/7

Model information system supporting medical diagnosis

Figure 22: Model information system supporting medical diagnosis

The design and installation of the cluster in the medical system should meet the following requirements:

- High availability requirements Network resources must be available in the highest capacity to provide and serve end-users and minimize unwanted system downtime

- High-reliability requirements High reliability of the cluster is understood as the ability to reduce the frequency of occurrences and to improve fault tolerance of the system

- Scalability requirement The system must be easy to upgrade and expand in the future Extensive upgrades include adding computers and devices to the system to improve service quality, as well as adding more users, adding applications, services, and additional resources

Conclusion and Recommendation

We have seen very clearly that the transition from paper medical to electronic medical records is not the only motivation for the evolution of personal health records A small but powerful push comes from the patient at the center when they are requesting access to and checking their health information at any time and in a simple, easy-to-do way The information system has been developed extensively today and the thesis has met that

The research focuses on promoting and applying IT in hospitals under Ministry of Health in prescribing electronic medicines, electronic patient records, and hospital management, establishing a support system for diagnosis To reduce the burden on patients, to reduce the overload of hospitals at the central level The report was developed for the treatment of eczema as a legal document on medical activity in patients Electronic medical records support research: clinical, health care, drug effects

Different doctors look at electronic records for further treatment according to the course of the disease

Human beings are following The notes, notes of previous doctors such as drug allergies, complications arising are doctors to know later and avoid harmful interventions for patients With the data saved Sometimes, with only one case, the physician can discover many interesting things for scientific research Hospital data after a period of accumulation will become the treasure of the doctoral students Electronic medical records play an important role in the training and research and also makes sense for the management and operation of the hospital in general Electronic medical records combined with a medical diagnostic system to transfer all the information: test results, X-ray images, magnetic resonance, endoscopic results, ultrasound, general diagnostic results and data Treatment includes both examination and medicine, surgery, hospital fees into structured data

Patients with the desire to quickly get rid of the disease may be treated in many other places

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Appendices List of acronyms

1) HIS: Hospital Information System 2) EMR: electronic medical record

3) PACS: Picture Achieving Communicating System 4) LIS: Laboratory Informatic System

5) RIS: Radiology Informatic System

6) DICOM: Digital Imaging and Communications in Medicine 7) HL7: health level

8) CDA: Command and Data Acquisition 9) CCD: Coupled Device

10)CDR: Critical Design Review 11)RIR: Radio interference Refractive 12)XQ: X-RAY

13)CDI: Certificate of Deposit

14)TCP/IP: Transfer Control Protocol/Internet Protocol 15)HER: electronic health record

16) MRI: Magnetic Resonance Imaging

17)PET: Positron Emission Tomography SPECT: 18)CT: Computed Tomography

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