[...]... late 1980s when data exchange between systems became more common and standards to permit this exchange were increasingly used This is by no means to imply that better ways to arrange computing aren’t possible—it is the authors’ hope that better clinical computing Practical Guide to Clinical Computing Systems: Design, Operations, and Infrastructure 13 Copyright Ó 2008 Elsevier Inc All rights of reproduction... just as they can and do help patients And just as we bring multidisciplinary teams together to find the root cause of problems and to correct the systems causing them, we all need to have better understanding of the root cause of IT problems and take informed steps to make problems less likely This book can provide some of that understanding of how clinical computing systems work Clinical computing systems... approaches can we hope to have the reliability we expect Yet there are no randomized controlled trials to guide us to the best way to select a clinical computing system, how to implement it, how to organize the information technology department, or to answer many other important questions that may help achieve reliable operations IMPORTANCE OF MONITORING PERFORMANCE Even when clinical computing systems... avoiding and correcting network outages, upgrading hardware and software, creating new interfaces between systems, and myriad other tasks that are often unnoticed by clinicians who use them Yet these tasks must be Practical Guide to Clinical Computing Systems: Design, Operations, and Infrastructure 1 Copyright Ó 2008 Elsevier Inc All rights of reproduction in any form reserved 2 Payne accomplished to continue... to constrain health-care costs and to improve quality and efficiency have led many organizations to turn to approaches used successfully in other Introduction and Overview of Clinical Computing Systems 3 sectors of society, including process improvement techniques and adoption of information technology RISING DEPENDENCE ON CLINICAL COMPUTING SYSTEMS The volume of information clinicians use in day -to- day... expertise in engineering, human factors, design, medicine, and also architecture It is the architect who melds design and function with engineering and practicality We look to the architect to keep parts functioning together, and to plan for changes and additions that fit with the original design Similarly, clinical computing systems have an architecture and often an architect behind them Particularly in an... hematocrit, many steps must work without fail The patient must be accurately identified and the blood sample must be linked to her The laboratory processing the specimen must have a functioning computing system, and the network connection between the laboratory computer and clinical data repository where the patient’s data are stored must be intact The computing system that directs the result to be... of a repository was developed in conjunction with the growth of the database management system industry A clinical data repository is a database optimized for storage and viewing of clinical information such as laboratory results, transcribed documents, and radiology reports, that is used to store data sent to it over interfaces from departmental systems A repository permits a clinician to use a web... patient safety, quality, and organizational efficiency Medical centers are heavily reliant on them to make it possible to care for hospitals filled to capacity The clinical computing systems and infrastructure are enormously complex and becoming more so, and they must operate reliably nearly continuously Clinicians are busy delivering care with little time for training and low tolerance for malfunctioning... result to be sent to the repository—an interface engine in many organizations—must also be functional The master patient index that clearly identifies the patient as the same person in the laboratory and clinical data repository must have assigned the same identifier to both systems Once the hematocrit result is stored in the clinical data repository, the clinician must have access to it from a functioning . Practical Guide to Clinical Computing Systems: Design, Operations, and Infrastructure This page intentionally left blank Practical Guide to Clinical Computing Systems: Design, Operations, and Infrastructure Edited. systems, and myriad other tasks that are often unnoticed by clinicians who use them. Yet these tasks must be 1 Practical Guide to Clinical Computing Systems: Design, Operations, and Infrastructure Copyright. and systematic approaches can we hope to have the reliability we expect. Yet there are no randomized controlled trials to guide us to the best way to select a clinical computing system, how to