Health care industry involves a lot of stakeholders, such as patients, physicians, clinicians, nurses, administrators, external care providers, etc., and each of these stakeholders needs to work with different types of information. Managing these volumes of information is costly and time-consuming; moreover, using paper records can lead to missing or inaccurate health record information. It is hardly possible to share information between different health care providers, and the records are often complex to understand for patients and their families. According to Szolovits (2003), paper record defects make health record information not available at up to 30% of patient visits. Currently, paper and electronic records of the hospitals are not integrated, thus resulting in reduced productivity and unavailability of full healthcare information for the patient.
These problems can be solved by implementing a unified database for keeping healthcare records and a database management system for accessing these records. The database basically is a collection of data and the description of these data, and database management system represents the mechanisms which allows different users to get proper access to these data and to manage them (Wager, Lee & Glaser, 2009). There is usually some client program which should be installed on the computers which works with the database management system and makes user access to the system quick and convenient.
Information in the database is stored in tables centered around a particular domain, such as schedule, patient care, patient administration, medical records, financial records, notes, observation reports, laboratory results, etc. The tables in the database are linked between each other so that all stakeholders can access the necessary information and receive it in easily readable and understandable form. Databases are also optimal for sharing and exchanging information, and these activities will take minimum time of healthcare professionals, allowing them to concentrate on the diagnosing and treatment. Moreover, databases are flexible, so it is easy to add any kind of data or to update the records. Databases use unique encoding for patients, medical professionals, diagnoses, laboratory results, etc. This feature makes it easier to exchange information and to present the information to external organizations.
Records stored in the database involve information generated by doctors, nurses, administrators, physical therapists, pharmacists, radiologists, office staff as well as by the patient on one’s own (e.g. health diary) (Wager, Lee & Glaser, 2009). There are numerous types of records (which are now mostly presented on paper) that should be included in the database: medical history and family history of the patient, results of physical examinations, current complaints and medications, notes of the doctors and nurses, health summaries, recorded signals, images produced by X-ray, ultrasound, MRI and other procedures, genetic information, and results of laboratory data and other numerical measurements (Wager, Lee & Glaser, 2009). Due to such diversity of data, it is critical to adopt comprehensive standards of terminology, data encoding and standardization before implementing the database. It is optimal to adhere to existing standards of data encoding in healthcare.
There exist standards for identifying health care providers in the database – UPIN for Medicare-involved physicians, and NPF for all health care providers (Blair, 1999). For labeling product and supplies, LIC, UPC and END systems are being used (Blair, 1999). There are also standards of communication and messaging in health care, the major of them being X12N system developed by ASC Committee, ASTM standards, DICOM (radiology standards) and HL7 – standards for all types of medical records (Health Level Seven International, 2011). HL7 is the format widely used in the US and it is also accepted internationally (Health Level Seven International, 2011); thus, it is possible to recommend to choose this standard as the basis for data encoding for the future database.
Blair, J. S. (1999). An Overview of Healthcare Information Standards, IBM Healthcare Solutions. Retrieved http://lists.essential.org/med-privacy/msg00186.html
Health Level Seven International. (2011). Retrieved from http://www.hl7.org/index.cfm?ref=nav
Szolovits, P. (2003). Nature of Medical Data. MIT, Intro to Medical Informatics: Lecture-2. Retrieved from http://groups.csail.mit.edu/medg/courses/6872/2003/slides/lecture2-print.pdf
Wager, K.A. & Lee, W.L. & Glaser, G.P. (2009). Health Care Information Systems: A Practical Approach for Health Care Management. John Wiley and Sons.