ELECTRONIC MEDICAL RECORD SYSTEM FOR PULMONARY DISEASE PATIENTS. IMPLEMENTATION AT SOTIRIA HOSPITAL, HELLAS

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1 ELECTRONIC MEDICAL RECORD SYSTEM FOR PULMONARY DISEASE PATIENTS. IMPLEMENTATION AT SOTIRIA HOSPITAL, HELLAS Nikolaos Apostolou, Georgios Karkalis, Costas Kyriakou, Maria Haritou, Dimitrios Koutsouris Biomedical Engineering Laboratory School of Electrical and Computer Engineering National Technical University of Athens Zografou Campus, Athens, Greece Tel: Fax: ABSTRACT Sotiria Hospital is one of the largest pulmonary disease hospitals in Greece. A huge number of patients visit it everyday. The implementation of an electronic medical record system for pulmonary disease and patient follow-up is expected to help substantially the hospital s clinical doctors in the every-day clinical practice but also for statistical and research reasons. This electronic medical record system will be applied to the Department of Respiratory Deficiency of Sotiria Hospital, but will have the ability to expand easily and communicate by exchanging information with other systems in other departments and hospitals. In order to satisfy these requirements, the proposed system is based on the industry standards, SQL and Java, avoiding compatibility issues and setting the basis of a future telemedicine system. Data stored in SQL databases are compatible with the leading Statistical Analysis Package, SPSS. Significant gains are expected: increase of the diagnostic reliability, better service to patients, less time consumption, advanced help in the field of statistical and clinical researches. KEYWORDS: database, electronic medical record, telemedicine, SQL, Java, SPSS. INTRODUCTION Health information systems are the intersection of information science, medicine and health care. They deal with the resources, devices and methods required to optimize the acquisition, storage, retrieval and use of information in health and biomedicine. Prior to deciding the implementation of a specific health information system each case should be studied separately and comprehensively. Incorporating patient administration and financial management procedures are intriguing. However, the cost and the technical difficulties are very high and some institutions cannot support them or prefer to make different financial planning, with emphasis on other needs of the health system. In the case of Sotiria Hospital in Athens, a simple approach was adopted. Sotiria Hospital is one of the largest hospitals of Athens and is composed of several different departments that are spread over a wide geographical area. A large number of patients visit it everyday and the hospital will benefit greatly from the implementation of an electronic medical record system. Our scope was to develop a record system complying with the standards of transmission and exchange of data. It should enable the rapid sharing between the different departments of the hospital, while fulfilling the demanding needs of a modern hospital.

2 METHODS AND MATERIALS The electronic medical record system we developed is applied to the Department of Respiratory Deficiency. It has the ability to expand easily and communicate with other systems so that, if proved efficient, similar systems may be applied to all the departments being able to exchange information among them as well as with other hospitals and institutions. The system is compatible with the standard programs for Statistical Analysis, so that useful conclusions and statistics may be derived from the information input to the system. The methods and the materials we used to develop this electronic medical record system were based on the industry standards and the research made in our lab. Compatibility issues and easy exchange of information aspects were taken into consideration. The selected system is an SQL database (a Database Management System that supports SQL) that is handled by a Java program (interface) and is compatible with the standard Statistical Analysis programs (in this case, SPSS is the selected statistical analysis package). SQL stands for Structured Query Language. It is a standard interactive and programming language for programmers to talk with databases through a Database Management System (DBMS). Using SQL, one can retrieve data from a database, create databases and database objects, add data, modify existing data, and perform other, more complex functions. With SQL, one can also change the server configuration, modify database or session settings, and control data and access statements. The strength of SQL is its universal acceptance by database vendors, thus minimizing compatibility issues and enabling the easy exchange of information among different (or similar) systems. Some common relational database management systems that use SQL are: Oracle, Sybase, Microsoft SQL Server, Access, Ingres, MySQL etc. For this project, the MySQL Database Management System was selected. The database holds all the personal and medical information of each patient and a diagram showing the problematic area that is under examination, medical images and/or video of the area, notes made by the doctor and the results of the examination (the basic diagnostic tool used in the Department of Pulmonary Medicine is bronchoscopy). Although the rules of minimizing data redundancy suggest that the information should be split into at least two tables (one containing the personal details of the patient and one holding the information relevant to the examination), after discussing with the doctors and the stuff that are going to be using the system at the Department of Respiratory Deficiency, it was revealed that in almost all cases each patient is subjected to just one bronchoscopy, and that it is much more convenient for the treating clinician to have a single table containing all the information. This table will therefore contain the following information: Date of Examination / Patient Number / Name / Surname / Age / Address / Telephone Number / Insurance / Symptoms / Preparation / Examination Type / Risk factors / Area to be examined / Images and video of the suspicious area -if any- / Results of the examination / Notes). The information of the field area to be examined will not be keyed-in. An easier and more user-friendly approach will be adopted: the interface will provide the user with a diagram of the respiratory system and the user will simply click on the area to be examined. The database is handled by an interface program, created using the Java programming language which makes it easy to transfer the electronic medical system to other platforms without re-writing anything. Special attention has been paid to the user-friendliness of the interface. The interface is tidy, simple to use and uses bright warm colors making it more appealing and inviting to the user.

3 Java technology (version 2) is both an object-oriented programming language and a platform developed by Sun Microsystems. Java technology is based on the concept of a single Java virtual machine (JVM) -- a translator between the language and the underlying software and hardware. All implementations of the programming language must emulate the JVM, thus enabling Java programs to run on any system that has a version of the JVM. In a general sense, the main benefits of the Java language are its portability across platforms and operating systems and its ability to be delivered over relatively low-bandwidth channels, such as dial-up communications. The language is also impressively scalable; existing applications can easily be adapted for devices with limited-memory resources. Additionally, because it was designed to run in a secure manner over networks, it affords this level of security when operating over the Internet, as well. In essence, Java technology extends a user s computing power from the desktop to the resources of the Web. The Java language is important because it is an open standard. Open standards let all technologies connect and integrate, making information transfer more modular and therefore, easier to design, update, and troubleshoot in an efficient and timely manner. Java was one of the first technologies to support open standards in the enterprise, opening the door to using XML and Web services to help share information and applications across business lines. Additionally, Java technology serves as the backbone of many products and consulting services [1,2]. Data stored in SQL databases are compatible with the leading Statistical Analysis Package, SPSS, which will be used so that useful conclusions and statistics may be derived from the information input to the database. SPSS is the leader in predictive analytics technologies. Corporations, academic institutions, healthcare providers, market research companies and government agencies use it to better focus their operations and improve their performance. SPSS software helps organisations optimize interactions, regardless of whether they involve patients, customers, employees, students or citizens [3]. RESULTS The system produced is composed of the first screen that appears when the program (interface) is executed. The user sees a reminder on what examination results are expected during the current day, and selects whether he/she wants to add a new entry or view/modify an existing one (see Figure 1).

4 Figure 1: The interface of the software When the user makes the initial selection ( new entry or browse existing entries ), a second window appears that is separated into two panes (tabbed pane). The first pane contains the personal information of the patient and all the necessary information prior to the examination (see Figure 2).

5 Figure 2: Patient info prior to examination The second pane of the second window appears during the use of the program (interface), which contains the results of the examination, in text and in a graphic manner as well. The user marks the problematic area just by clicking on the diagram, and stores imaging and video material gathered during the examination (see Figure 3).

6 Figure 3: Examination results The benefits of the implementation of an Electronic Medical Record System at Sotiria Hospital are expected to be significant. The most obvious advantage will be the fact that a significant amount of time will be saved, leading to increased productivity from the doctor s side and less hassle and better service for the patients. At the time present, all data is printed and placed inside physical folders. Looking for a patient s folder can take up a significant amount of time, causing frustration to the patient and the doctor. Also, because of this delay, fewer patients get treated. This is an important problem for Sotiria Hospital because many patients line up each day. With the implementation of the Electronic Medical Record System, this delay will be limited to a bare minimum so there will be less frustration for both the doctor and the patient, and more patients will get treated each day. Also, it will be a lot faster to make research having access to medical data anytime, anywhere. It is obvious that time saving and efficient time-planning, impact in a straight-forward manner on the general cost effectiveness. Financial benefits for the hospital administration are therefore

7 also anticipated by the implementation of health information systems like the one developed in the framework of this project. At the same time, the data in the Electronic Medical Record System will not be as sensitive as the printed data of the current system, which are prone to damages due to usage and time (papers get torn or wrinkled or change color and ink fades). The only danger for the data in the new system will be technical faults of the equipment, which can be minimized by taking frequent backups. Another useful feature of the new system is the existence of reminders i.e. programs that remind the doctor when the results of certain examinations are going to be out and important tasks that have been scheduled and must not be neglected. Very important is the fact that steps have been taken in creating the Electronic Medical Record System, so that applications of telemedicine can be developed later on. Telemedicine, the use of communications and information technologies for the delivery of clinical care, is probably the future of the health system. Recent advances in telecommunications and Internet, has now made it possible to break geographical barriers and allow physicians to deliver health care to patients at any time and any place basis (Mason, 1998). These systems require extensive investments towards the design, implementation and maintenance of telecommunications infra structure. However, the widespread growth of the Internet is beginning to give us an alternative. The versatility of the Internet in terms of being able to carry multimedia such as voice, video and data, combined with its low operating cost features makes it an attractive medium for telemedicine consultations. Advances in data compression, security, cross platform software and development of modeling techniques in designing distributed networks also hold the Internet as a promising new tool for future telemedicine applications. The most important tools in such an exchange of information over the Internet are SQL databases (databases that utilize SQL), which is also the basis of the Electronic Medical Record System for Sotiria Hospital. Last but not least, an important aspect deriving from the implementation of Electronic Medical Record Systems is their use for statistical purposes and clinical research. Proper assessment of the processes and outcomes of care is required before resources can be appropriately allocated and care interventions can be planned. Having reliable clinical data would therefore be invaluable in making decisions and planning interventions. Using the Electronic Medical Record System to identify patients for prospective investigations and collecting outcome data can increase the efficiency of such investigations. The system can be used to enhance longitudinal care and disease management, both at the level of the individual patient through the health center and even to higher levels of health system management. DISCUSSION Sotiria Hospital will benefit greatly from the implementation of a health information system. After careful consideration, it was decided that the best system for this specific project is an Electronic Medical Record System that will be applied to the Department Of Pulmonary Medicine as a first step. The Electronic Medical Record System will be built using the current industry standards (an SQL database handled by a Java interface), with special consideration for future expansion and development of a telemedicine system. Significant gains are expected, especially saving time and increasing productivity, as well as in the field of statistical and clinical researches, where it can prove to be an extremely valuable tool.

8 AKNOWLEDGEMENTS This work has been co-funded 70% by the European Union (EU) European Regional Development Fund (ERDF) 30% by the Hellenic Republic Ministry of Development The General Secretariat for Research and Technology (GSRT) in the framework of Measure 4.2 of the Op. Pr. Competitiveness of the 3 rd Community Support Programme. The authors would like to thank the Sotiria Hospital and its clinical doctors. Special mention should be made to Dr N. Lolis, who become personally involved in this project. REFERENCES [1]. IBM official web site (2007). Available in [2]. Sankaran M. R. (2000). A Web-Based Correctional Telemedicine System with Distributed Enterprise (Maui, Hawaii, Jan , proceedings of the 33 rd Annual Hawaii International Conference on System Sciences) [3]. SPSS official web site (2007). Available in