Monday, January 19, 2009

Clinical Information System Request for Comment

The ACT Government has issued a request for comment for a draft "Clinical Information System: Intensive Care Unit" for Canberra hospitals. Having had recent first had experience of being in the system and attended a talk on ICT in Health Delivery in the 21st Century I found this of interest. One aspect of the requirements is the use of a web interface:
Functionality unique to the ICU environment (representing well over 80% of clinical care delivered in the ICU):
• Real time interfacing to unique bedside devices and equipment
• Flow-sheet and decision support assisting clinical decision making using unique parameters with unique clinical interrelationships
• ICU specific medication management with a superset of medications prescribed in a unique environment
• Maintain the patient’s medical record for the duration of their ICU stay in accordance with legislated requirements for record keeping and contribute to the centralised hospital clinical record.
• Retain records of all interactions and interventions applied to the patient.
• Manage the large volume of data obtained from the regular and frequent downloads from monitors and ventilators, with the ability to drill down to the smallest time interval captured from each device
• Assist in the reduction of errors associated with patient records relating to legibility and calculations.
• Assist in the reduction of errors associated with the prescribing and administration of medication.
• ICU specific terminology for clinical notes and pathways tightly integrated to the decision module
• Have the ability to take information stored about one intervention or modality and populate it through related clinical flowcharts / forms
• Assist in the medical/nursing care of the patient by facilitating the tracking and recording of medical/nursing tasks.
• Remove the need for unnecessary duplication or reproduction of patient data
• Provide query and reporting capabilities including standard and ad hoc reports to meet the requirements of - Commonwealth, Territory, Facility, ICU, Research, ANZICS, ANZPIC
• Provide ad hoc and standardised reporting functionality for quality improvement activities and improved clinical management
• Provide the ability to perform timely audits including the provision of a clear audit trail.

Functionality provided by interfacing with other Clinical Systems:
• PAS (ACTPAS at TCH, and IBA at Calvary)
o Obtaining Patient Identifier and Demographic information, to do the following:
• Patient registration
• Patient admission and discharge
o Episodic Information
• Patient bed movement within and outside the ICU, for example, whilst in
o Viewing of medical images / reports
• Pathology Information System
o Importing a subset of available atomic pathology results, to allow intelligent decision rules to be used, for example, low potassium level and alert would flag the user to this situation and suggest a predefined course of action; and the viewing of all pathology results and medical imaging reports via a web-browser interface
o Export of data to centralised TCH Clinical record
• Future Scope
o Ordering of diagnostic imaging and pathology requests
o Pharmacy (Medication and Infusion Management).
o Provide Pharmacy electronic ordering and bar-coding capability.
o System to integrate with Clinical Portal application
o All environments to be integrated into one environment
The solution should be suitable for use in an acute clinical environment by providing the following general features:
• Easily navigable
• Facilitating the recording of clinical data in a structured (e.g. selection from reference table, numeric), and unstructured (free text) format.
• Intuitive (e.g. requiring minimal training for use).
• Presentation of patient data in clear and informative manner.
• Easily and extensively configurable ...

From: Clinical Information System: Intensive Care Unit, Statement of Requirements, ACT Health, January 2009

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