Design

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Design

The InHCc System is Designed by efficiency experts that provide better design and organization features (does not always nor is it intended to function “like the healthcare professional in the real world”…Once the healthcare professional get use to the new design, they will find it faster and simpler to use….

The system is not designed how healthcare professionals think about and carry out processes. First there are no two healthcare professionals that think the same way or had the same education and training. Physicians are never trained in exactly the same way. They do not go to the same school, they do not live in the same locations, and they do not have the same beliefs about health care....Maybe for once, we really should have a look at best practices!

Design is based on a careful review of how processes should be preformed effectively and efficiently and the data that is needed in each step, This workflow analysis has been performed for years in business but seems to have completely overlooked in healthcare. While physicians have been consulted as to how what they require, many different types of experts have come together to design the workflow.

As seen from the definition in the Stakeholder section, there are many shareholders...the most important being the individual. However, is seems that from reading the literature (in regards to accepting a Information System), the physician is the only stakeholder (and that is probably because the system must be sold to him). Much is made of the fact that it is hard to get the healthcare professional to "buy into" information systems. That it takes too much time for the physician to enter the data, or that they have to enter too much data, or that is not the way they do things. Physicians also say that information systems (Computers in this case) are too obtrusively and it interferes with their face to face meeting with their clients.

The physician is only one small part of the overall system

Now think about this...if the information that the physician collects is used for data analysis to improve the overall health of the population and the procedures that he is required to follow are evident based medicine that lead to more cost effective medicine...Is it really important that it takes him a little longer to enter the data, or that it is not what "he is use to doing?" Think about the other shareholders that his processes do benefit. Since Healthcare is one of the largest industries in any country, how can we not consider the other players?

InHCc believes that the system should be designed by professionals.

Patient's information should be immediately available. Summary data should first be presented, and detail information viewed by clicking on a summary record. No information is deleted.

All procedures are different, screens should be designed that present all concepts that is required and the data sets that are required by each concept.

Integrated System

All systems use the same Centralized database. External data is regularly imported into the Centralized System

Scalable: The InHCc uses Microsoft's products. The type of product depends on the size of the Organization and is fully scalable to any size.

The InHCc HMIS system scales from

One Healthcare Professional Medical Office
Small Clinics
Hospitals
Corporate Healthcare Organizations
Municipal, State and Federal Government

The system addresses the minimal requirements of each stage and easily upgrades to the next level.

Implementation of the InHCc System can begin at the lowest level by the one person individual in his office and be expanded to the national or international level. The System can be used on a laptop in the field and it can be used at the Enterprise database operating systems at the Organizational, National or International Levels.

Benefits:

Completely Integrated system
Simple to use and no duplication of application
The screen view that the user sees can be exactly the same as any other level or customized.
Any level can view all data ("Drill-Down" - all detail information can be viewed no matter at what level the user)
Fast and easy access to any module
Easy to learn

User Presentation

The InHCc System uses Microsoft’s Visual Basic. Net application programs as the front-end presentation tool and is easily modified to fit the user organization’s needs. Provides customized interfaces based on the roles and requirements of different stakeholders. There can be unique views for physicians, nurses, administrators, management, and external stakeholders...but each access the exact same data.

Customizable
Provides customized interfaces based on the roles and requirements of different stakeholders. There can be unique views for physicians, nurses, administrators, management, and even external stakeholders.
Easy to use point and click entry of information.
Input selections are either “drop down” input fields or “picklist” where data can be clicked to add to the input fields. Very little data is “keyed” into the database.

Data is entered at the point of contact. Once this information is entered, the user does not have to reenter that information into other forms. All contact information is carried from document to document automatically.

Customizable

Custom interfaces based on the roles and requirements of different staff members. Unique views can be created for physicians, nurses, administrators, or management.

The InHCc System uses Microsoft .Net technology. Although helpful, advance programming techniques are not needed to made simple changes and there is no need for onsite IT support once the system is established.

Modular Design

The InHCc Information is modular and can be used in its entirety or one section at a time. Each separate modular or new modular can be either easily added or removed without affecting the overall “Enterprise” system. Within the modular features can be easily removed or added.

Design Benefits:

Completely integrated system
User needs only to see the data that he directly uses and has permission to see
Increases security because the user only has access to the data that he directly needs for his job.
New Applications can be easily created and added without effecting other applications
Data is collected only once but is available throughout the system based on need.

Point of Care Data Entry

Direct data entry by the healthcare professional at the point of care optimizes data collection. Enter one-time, use many times.

Benefits:

Direct data entry provides interactive edit checks and dialog boxes that provide the following:

Help information. Information on what and why the current information in the data field is used
A list of standard values to choose from for that data field: Examples are:
- City/Town (checks spelling and provide automatic coding)
- Male/Female
- Very Low, Low, Average, High, Very High
Accept only a value that is within a certain value range. Examples:
- Temperature can only be between 27 and 42 degrees
- Birth date can only be less than today's date
- A child cannot be older than the parent
- A list of predetermined values (the domain of values)
Ability to NOT allow the user to exit the document until ALL the information is completed
Error messages when incorrect information is entered. Example:
- Male patient cannot have a hysterectomy

In many existing medical record systems, the data is frequently entered by surrogates for the health care professional. In such circumstances, two opportunities exist for less than perfect data capture:

Insufficient specificity by the Healthcare Professional
Inaccurate replication by a transcriber

Administrative Standards

(see Health Informatics - Administrative Standards)

Identifiers

Identification will be established by assignment of a unique identifier to individual, households, and organizations. Along with this identifier, entity attributes will be used for verification.

Client Identifiers

In many countries, the citizens are assigned an identification number by the local government. Where this occurs, this assigned number (social security number, etc) may be used on all records. (see Patient Identification under "Security").

A unique world patient identifier must be created where the client has the ability to move between government areas (different coding systems). This unique code may only be created in some way using the client's own biometric make-up. Unique numbers cannot be created using a birthday, birth location, parent, etc because the client may give different different information at different times (unless the unique number is created at the time of birth by an authorized agent.

As the cost involved in using biometric devices is beyond the budget of the average clinic. InHCc will use the local government assigned national identification number. Where the government does not assign unique identifiers, a numbering system will be developed for that country.

Provide Identifiers

All medical care providers should be assigned a unique identifier by the national government (example HCFA's Universal Physician Identifier Number (UPIN). However, this suffers from the same problems as the client identification. The same arguments can be give for this identifier as the client identifier.

Site of Care Identifiers

The site or location of care must also be assigned a unique identifier. The use of the address of a particular institution or office is not sufficient because in many cases the institution or office may move to a different location or the institution may open several offices Analysis by zip code does not give sufficient information for research. While the GIS number should be used to identify a "location" for treatment (and also the address of the client), a identifier should also be created for the "organizational" unit itself.

Physical Architecture

Health Care Units. A hypothetical physical Health structural will be based on Three Levels of Health Care Services: Lower Level entry point, Middle Level Referral, and Higher Level Referral.

IT Facilities. IT units will be designed from the point of view of the three levels of data requirements: Data Collection, Data Storage, and Data Presentation.

Extranets. The information within the system will be transferred from location to location by a special intranet-only category. An extranet is an extension of an organization's private intranet to permit access by other authorized organizations, such as donors. Outside organizations use a secure connection to the extranet by a virtual private network (VPN) that encrypts transmissions,.

Healthcare "Record" Architecture

There will be no single Healthcare "Record" or Single "Computerized Patient Record" but rather a collection of records built upon a relational database.

DATA Transfers

Date transferred to Central Data Warehouse using Microsoft S Replication techniques over normal telephone lines and/or Microsoft Data Transformation Services

InHCc was developed to make transfers when not connected to the Internet by using either a Telephone connection and Replication (Microsoft term for a type of date transfer) or “walk it in” with the data copied to a CD.

Application Updates

InHCc uses the “One Click” method of Microsoft for updates to the system. The computer can be automatically set to check for updates, if a update is available, it is automatically downloaded and installed onto the computer.

Updates are on-going and Suggestions for new modular can be easily made through the InHCc Web site.

Applications

Menu and Tool Bar

The Menu and Tool bar displays different options depending of the screen.

The most important features are:

Action
- Update to Personal data: This feature lets the User update aspects of their personal that does not require authorization such as Telephone numbers and Address. This helps Human Resources in the maintenance of Personal personal data.
Reports (Documents, Policies, Lists, Procedures, Operational Reports)
Resources (Help Desk, Training, Suggestions and Problems, Search Knowledge Base, Experience Improvement Program, "Ask the Community", and Scan Document)
Help
References per Internet
Administration
User alerts

Reports

This feature accesses the InHCc Web based Microsoft Reporting Service. All Reports are located and Maintained on this site.

Policies

Policies are all policies of the organization. They include working policies and all polices required by certification organizations).

Procedures

This is a description of all Procedures that all performed within the organization. This is an extensive list maintained on the InHCc Reporting Service

User Alerts

Alerts for this particular log-in user. Alerts concerning the user's patients or other communications that are addressed to this individual.

These Alerts may also be related to the User's patients.

Organization Notices

This features allows the organization to sent general notices and news to the employees.

Scheduler and Organizer

The InHCc uses Microsoft's Outlook to allow for scheduling of staff (this is not the appointment scheduler).

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