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EMR - Software & HardwareEMR - Software & Hardware
T. RathinamMedical Research Foundation
5th Aug 2006
T. RathinamMedical Research Foundation
5th Aug 2006
ApplnApplnServer
Server
Scan
ners
Scan
ners
NetworkNetwork
PCs
PCs
DD’’ P
enPen
TCs
TCs
WiWi--fifi??????
BackupBackupServer
Server
5th August 2006 www.sankaranethralaya.org 2
Pieces of PuzzlePieces of Puzzle
! Software
! Hardware
! Soft-Hard-Ware
! How to go about?
! Software
! Hardware
! Soft-Hard-Ware
! How to go about?
5th August 2006 www.sankaranethralaya.org 3
S/w & H/wS/w & H/w
! Software?
! Hardware?
! Software?
! Hardware?
- Mind
- Money
5th August 2006 www.sankaranethralaya.org 4
SoftwareSoftware
Front End! VB
!Easy! Inexpensive
! Java/ J2EE!Cost effective
Front End! VB
!Easy! Inexpensive
! Java/ J2EE!Cost effective
5th August 2006 www.sankaranethralaya.org 5
SoftwareSoftware
! Java/ J2EE/ .Net! Integration!Web based! Internet Browser ! Internet + VPN
! Java/ J2EE/ .Net! Integration!Web based! Internet Browser ! Internet + VPN
5th August 2006 www.sankaranethralaya.org 6
SoftwareSoftware
Back End! Linux
! Redhat
! MS 2000
! Unix
Back End! Linux
! Redhat
! MS 2000
! Unix
5th August 2006 www.sankaranethralaya.org 7
SoftwareSoftware
Database! Oracle
! MS – SQL 2000
! DB2
! Interbase
Database! Oracle
! MS – SQL 2000
! DB2
! Interbase
5th August 2006 www.sankaranethralaya.org 8
SoftwareSoftware
! To comply with Standards! HL-7! DICOM! CPT for Surgical Procedures! SOAP (Protocol)! HIPA for Insurance! NABL (National Accreditation Board for
Labs)
! Interface with other applications
! To comply with Standards! HL-7! DICOM! CPT for Surgical Procedures! SOAP (Protocol)! HIPA for Insurance! NABL (National Accreditation Board for
Labs)
! Interface with other applications
5th August 2006 www.sankaranethralaya.org 9
H/W– Clinical AspectH/W– Clinical Aspect
! TCs! PCs! Digital Pad! PDA! Scanners
! Document! Film
! TCs! PCs! Digital Pad! PDA! Scanners
! Document! Film
Server
Clin
ical
Sid
e D
evic
es
5th August 2006 www.sankaranethralaya.org 10
H/W– Clinical AspectH/W– Clinical Aspect
! Interfacing hardware with equipment! Imaging Equipment
! Fundus Camera, OCT, HRT etc
! Diagnosis Data Equipment! HFA, Auto-Ref, Auto-Keratometer, DBR etc
! Wireless Network! Security
! Interfacing hardware with equipment! Imaging Equipment
! Fundus Camera, OCT, HRT etc
! Diagnosis Data Equipment! HFA, Auto-Ref, Auto-Keratometer, DBR etc
! Wireless Network! Security
5th August 2006 www.sankaranethralaya.org 11
H/W- IT Systems AspectH/W- IT Systems Aspect
! Server! Application! Database! Backup! Others
! Desktop Workstations
! Server! Application! Database! Backup! Others
! Desktop Workstations
5th August 2006 www.sankaranethralaya.org 12
H/W- IT Systems AspectH/W- IT Systems Aspect
! Hardware ! High processing speeds to run difficult
networks! High storage capacity! Although equipment will continue to
become more compact, faster & cheaper –What is purchased today will work effectively in office for next 5yrs.
! Hardware ! High processing speeds to run difficult
networks! High storage capacity! Although equipment will continue to
become more compact, faster & cheaper –What is purchased today will work effectively in office for next 5yrs.
5th August 2006 www.sankaranethralaya.org 13
HardwareHardware
! Storage! Typical EMR Requirement 3 Terabytes in 2
to 3 years! Scalability upto 5 TB! Archiving Policy
! Online! Offline! Inline
! Storage! Typical EMR Requirement 3 Terabytes in 2
to 3 years! Scalability upto 5 TB! Archiving Policy
! Online! Offline! Inline
5th August 2006 www.sankaranethralaya.org 14
Server Server
HardwareHardware
! Storage! High Availability! Proven track-
record ! Depends on
criticality! Basic
! Redundant Array of Inexpensive Disks- RAID! RAID Level 5
! Storage! High Availability! Proven track-
record ! Depends on
criticality! Basic
! Redundant Array of Inexpensive Disks- RAID! RAID Level 5
HD1HD2HD3HD4HD5
R1R2R3R4R5
5th August 2006 www.sankaranethralaya.org 15
HardwareHardware
! Storage! Sophisticated
! SAN! Ideal! Expensive
! Storage! Sophisticated
! SAN! Ideal! Expensive
Blocks
Blocks
Blocks
Blocks
Blocks
Blocks
5th August 2006 www.sankaranethralaya.org 16
Hard-Soft-WareHard-Soft-Ware
! Redundancy/ Load Balanced
! Application Server
! Database Server
! Redundancy/ Load Balanced
! Application Server
! Database Server
LAN
ApplicationServers
5th August 2006 www.sankaranethralaya.org 17
Hard-Soft-WareHard-Soft-Ware
! Redundancy/ Load Balanced
! Networking! Switches! Connectivity
! Power! UPS for an UPS
! Redundancy/ Load Balanced
! Networking! Switches! Connectivity
! Power! UPS for an UPS
Blk 1DC Blk 2
Blk 3
5th August 2006 www.sankaranethralaya.org 18
Hard-Soft-WareHard-Soft-Ware
! Backup Policy! Log backup
! Typically 15 mins! Disk to disk
! Overall backup! End of the day! Disk to Disk to Tape
! HD-HD-ALT
! Backup Policy! Log backup
! Typically 15 mins! Disk to disk
! Overall backup! End of the day! Disk to Disk to Tape
! HD-HD-ALT
5th August 2006 www.sankaranethralaya.org 19
H/W- IT Systems AspectH/W- IT Systems Aspect
! Network! Design addressing the extra-Bandwidth
Requirements! Redundancy
! Disaster Recovery
! Network! Design addressing the extra-Bandwidth
Requirements! Redundancy
! Disaster Recovery
5th August 2006 www.sankaranethralaya.org 20
When to go for EMR? When to go for EMR?
1.Starting a new clinic2.Remodelling a old clinic3.Adding a remote clinic4.Availability of funds5.Current billing or scheduling software needs
updating6.Concerns about the practice’s ability to meet
the Health care financing administration’s billing guidelines and to provide appropriate legible documentation
1.Starting a new clinic2.Remodelling a old clinic3.Adding a remote clinic4.Availability of funds5.Current billing or scheduling software needs
updating6.Concerns about the practice’s ability to meet
the Health care financing administration’s billing guidelines and to provide appropriate legible documentation
5th August 2006 www.sankaranethralaya.org 21
How to go about?How to go about?
1. In-house/ Out-Sourced2. Analysis of the current system3. Depicting the required system4. GAP!5. Identifying the developers6. Process of making it7. IMPLEMENTATION (Plan & Execution)8. Maintenance
1. In-house/ Out-Sourced2. Analysis of the current system3. Depicting the required system4. GAP!5. Identifying the developers6. Process of making it7. IMPLEMENTATION (Plan & Execution)8. Maintenance
5th August 2006 www.sankaranethralaya.org 22
EMR
HMS
Patient Services
Visionary Organization
5th August 2006 www.sankaranethralaya.org 23
A Sankara Nethralaya Presentation…
5th August 2006 www.sankaranethralaya.org 24
Need?Need?
Need = Requirements + ExpectationsNeed = Requirements + Expectations
5th August 2006 www.sankaranethralaya.org 25
NeedNeed
! Requirement! Medical Record (Physical)
! Expectations! Image Management! Direct Data Acquisition ! Intuitive
! Requirement! Medical Record (Physical)
! Expectations! Image Management! Direct Data Acquisition ! Intuitive
5th August 2006 www.sankaranethralaya.org 26
S/W- Clinical AspectS/W- Clinical Aspect
! Data Interfaces! Other packages! Equipment
! Slit Lamp Imaging, Fundus Imaging, HRA/ HRT/OCT/ GDx & others
! Auto-Ref data, DBR/ Keratometer Values, Perimeter Data, etc
! Avoid dead data!! Documents as images! Images without any search-ability
! Data Interfaces! Other packages! Equipment
! Slit Lamp Imaging, Fundus Imaging, HRA/ HRT/OCT/ GDx & others
! Auto-Ref data, DBR/ Keratometer Values, Perimeter Data, etc
! Avoid dead data!! Documents as images! Images without any search-ability
5th August 2006 www.sankaranethralaya.org 27
S/W- Clinical AspectS/W- Clinical Aspect! Standards
! ANSI HISPP! ANSI HISB! CPRI! FESMCC! HIMA! HIMSS! HOST! MRI! NIST! WEDI! ANSI ASC X12! ASTM Committee E31! HL-7! HIBCC! IEEE! NCCLS! DICOM! NCPDP! NISO! NUBC! ACGIH! Facct! JCAHO! NCQA! URAC
! Standards
! ANSI HISPP! ANSI HISB! CPRI! FESMCC! HIMA! HIMSS! HOST! MRI! NIST! WEDI! ANSI ASC X12! ASTM Committee E31! HL-7! HIBCC! IEEE! NCCLS! DICOM! NCPDP! NISO! NUBC! ACGIH! Facct! JCAHO! NCQA! URAC
! DHHS Data Council! HISSB! NCVHS! CEN/TC 251! EDIFACT! ICE! NAHDO! NAPHSIS! NASIRE! NHIRC! COSTART! CPT-4! HCPCS - HCFA! ICD! AICD-10 CM! ICIDH! ICPC! LOINC! NDC! SNOMED! UMLS! LTCCUDS! MDS! UACDS! UHDDS
! DHHS Data Council! HISSB! NCVHS! CEN/TC 251! EDIFACT! ICE! NAHDO! NAPHSIS! NASIRE! NHIRC! COSTART! CPT-4! HCPCS - HCFA! ICD! AICD-10 CM! ICIDH! ICPC! LOINC! NDC! SNOMED! UMLS! LTCCUDS! MDS! UACDS! UHDDS
5th August 2006 www.sankaranethralaya.org 28
S/W- Clinical AspectS/W- Clinical Aspect
! Standards! CPT-4 - Current Procedural
Terminology! Created and maintained by the
American Medical Association, which holds the copyright. Required for reporting of outpatient procedures and physician services in the United States.
! Standards! CPT-4 - Current Procedural
Terminology! Created and maintained by the
American Medical Association, which holds the copyright. Required for reporting of outpatient procedures and physician services in the United States.
5th August 2006 www.sankaranethralaya.org 29
How to purchase an EMR?How to purchase an EMR?
! Software not able to offer similar guarantees as Hardware companies
! Need a successful software company who can offer a long-term technical support and frequent updates.
! Software not able to offer similar guarantees as Hardware companies
! Need a successful software company who can offer a long-term technical support and frequent updates.