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Overview of System Architectures
By Dr. Richard J. Mata; MS, CIS, CMP™ (Hon)
Hospitals can use a variety of configurations for Health Information System [HIS] implementation depending on business needs and budgetary constraints.
Staffing needed for these systems can range from a few full-time equivalents (FTEs) per 100 beds for very basic off-site processing systems to 15 or more FTEs per 100 beds for sophisticated systems that attempt to combine several architectures into one system (e.g., combination of client-server systems with mainframe processing).
Resource use and customizability tends to vary in tandem; the greater the flexibility of the system to meet unique user needs, the greater the cost outlay for capital and/or additional FTEs.
Relationship of Resource Use and Customizability Based on System Architecture Selected
|
Values range from one (low) to four (high) stars |
||
|
Architecture |
Hospital resource use |
Customizability |
|
Off-site processing |
* |
* |
|
Turnkey systems |
** |
** |
|
Mainframe systems |
*** |
*** |
|
Client-server |
*** |
**** |
The basic system architecture possibilities are as follows:
-
Off-site (remote) processing: In this case the hospital contracts with a vendor external to the hospital. The hospital sends data over to the vendor site where the actual processing takes place. When processing is complete, the vendor sends the data back to the hospital, usually in electronic form.
-
Turnkey systems: A vendor provides the hospital with systems that are “pre-packaged” so that hospital-based system development is minimal. Limited customization of the system is possible using systems analysts or programmers.
-
Mainframe systems: Most applicable to large hospitals, this configuration is highly centralized. A large and powerful computer performs basically all the information processing for the institution and connects to multiple terminals that communicate with the mainframe to display the information at the user sites. Hospital Information Technology (IT) departments usually use programmers to modify the core operating systems or applications programs such as billing and scheduling programs.
-
Client-server systems: In this configuration one or more “repository” computers exist, known as “servers,” that store large amounts of data and perform limited processing. Communicating with the server(s) are client workstations that perform much of the data processing and often have graphical user interfaces (GUIs) for ease of use. Both customizability and resource use is high, depending on the desired sophistication. Many clinical information systems that process data directly related to patient care use this configuration.
Assessment
The above architectures are broad categories. Modifications and combinations of the above also exist, such as the use of client-server technology with mainframe systems and the addition of wireless technology and personal digital assistants (PDAs) to supplement the core computing functionality. In considering the optimal architecture for a hospital, management needs to take into account factors such as size of the institution, desired sophistication of the application, IT budget, and anticipated level of user community involvement.
Can you improve on the basic system architecture outlined above; or does your institutional have a different HIS architecture?
Conclusion
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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com
OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:
- PRACTICES: www.BusinessofMedicalPractice.com
- HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
- CLINICS: http://www.crcpress.com/product/isbn/9781439879900
- ADVISORS: www.CertifiedMedicalPlanner.org
- FINANCE: Financial Planning for Physicians and Advisors
- INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
- Dictionary of Health Economics and Finance
- Dictionary of Health Information Technology and Security
- Dictionary of Health Insurance and Managed Care
Resource use refers to the need for FTEs and hospital capital expenditure.
Customizability refers to the ability for users to alter the system structure or function to meet the unique needs of the institution.
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“Dirty-Claims”
Did you know that healthcare industry claims processors reported at least a four-fold increase in rejected Medicare claims, and a doubling of rejection rates for so-called “dirty” claims processed by the Blue plans on May 23, 2008?
As readers of the Executive-Post are aware, this was the first day that the federally mandated National Provider Identifier [NPI] was required. And, the rejection rate spike was similar or even higher for Medicaid claims. Are you surprised?
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