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Brief Report   |    
A Computerized Patient Information System in a Psychiatric Hospital
Ilan Modai, M.D., M.H.A.; Michael Ritsner, M.D., Ph.D.; Henry Silver, M.B.B.S, F.R.A.N.Z.C.P.; Rena Kurs, B.A.
Psychiatric Services 2002; doi: 10.1176/appi.ps.53.4.476
Abstract

The authors describe a computerized patient information system at a psychiatric hospital in Israel. The system is a fully implemented work instrument that promotes clinical safety and cost containment. It allows interactive online consultations, clinical cross-checking, the production of computerized reports and schedules, fast response to laboratory results, and safer drug administration, all of which help improve the quality of care. Cost savings have been achieved in areas such as pharmacy and food distribution. The initial investment in the system was $400,000, which is expected to be recouped after 11.4 years.

Abstract Teaser
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The advantages of electronic patient records have been discussed extensively (1,2,3), and there is an abundance of literature on how to implement these information systems (4,5,6). Nevertheless, the efficient implementation of electronic patient record systems is yet to be achieved at many institutions. Most systems are dedicated to specific medical fields or tasks and must be integrated into a hospitalwide information system (5).

The Mayo Clinic has reported on its success in converting laboratory data into information that can be used to improve patient care (4). Prescription management systems have been designed to facilitate accurate prescriptions, which has reduced pharmacy costs (2). Greemes and associates (4) and Modai and colleagues (7,8) have noted the importance of alert systems in clinical practice. Knaup and associates (5) have described heterogeneous hospital information systems aimed at supporting physicians in their daily clinical work. Cost-effectiveness and quality of care are also major considerations (9).

Here we describe a computerized patient information system being used at Sha'ar Menashe Mental Health Center in Israel. The system is a fully implemented work instrument that promotes clinical safety and cost containment.

The computerized patient information system, which was implemented in our hospital in 1997, runs on a Novell local area network (LAN) that includes 150 workstations and is installed in 17 units. The system provides for all practical patient-related needs: medical files, correspondence, dictionaries, hospitalization summaries and reports, laboratory test results, prescriptions, assessment scales, and patient labels (10). The database—called CLICKS, for clinical records—is a commercial product of Rosh-Tov Limited, Beer-Sheba, Israel.

The first author began using CLICKS in the hospital's psychiatric department. Patient records maintained by the department include demographic information; personal and medical histories; records of the initial patient interview, daily functions, and follow-up information from nursing staff; assessment scales; vital signs; current psychiatric status and diagnosis; follow-up information on medication and information from psychiatrists, psychologists, social workers, criminal justice personnel, and occupational therapists; expert consultations; and results of imaging tests, physical examinations, and laboratory tests. Previously entered information automatically appears in the appropriate fields on the screen. All frequently used expressions, jargon, and codes are retrievable online. Individualized internal and external correspondence can be produced automatically, as can medical and statistical queries. Laboratory results are automatically entered into the patient's record. Cross-check reports alert the attending staff to pathological or missing laboratory results (7,8).

The patient information system is exceptionally user-friendly and thus was readily accepted by the medical staff at the hospital. In addition, the hospital director was personally involved in training all staff members, one department at a time.

Therapists working at individual workstations enter data directly into patients' files. The therapist generates medical instructions, prescriptions, correspondence, holiday passes, hospitalization summaries, and assessment scales as well as nursing, scheduling, and cross-check reports. Printouts are signed as required by law. Staff meetings take place in front of computer screens rather than over handwritten files. The use of pencils is minimal, and secretaries rarely type letters from scratch. Each department head reviews all follow-up visits and appointment schedules.

The attending psychiatrist enters queries into the patient's record, and the nonpsychiatric consultants—for example, neurologists and internists—review these queries daily in their offices, entering the required information directly into the patient's file in the case of recurrent problems or responding to the query by telephone or by visiting the patient. Data can be entered either from the psychiatric department or from the consultant's office.

The pharmacist can produce medication reports for all patients in the department and for individual patients and supplies medications on the basis of dosage information in the system. The hospital director can reply promptly to internal and external questions or requests by retrieving information in the system. General statistical queries are easily processed. Cross-check reports produced daily in the general director's office enable the director to supervise clinical work in the various units from his workstation.

Automated entry of laboratory results and the ability to cross-check reports means that human error is reduced and that clinical problems can be identified more quickly. Automated medication reports and prescriptions improve the safety of drug administration. Multiparty expert consultations can be conducted online, and all the pertinent data are readily accessible by all parties.

In the past year, cross-checking from the hospital director's workstation generated 70 consultations, many of them related to blood lithium concentrations and agranulocytosis associated with clozapine or carbamazepine treatment. Eight patients benefited from early detection of irregularities and initiation of critical medication adjustments.

The initial investment in the LAN was about $400,000 for hardware, software, and optic communication lines covering the 740,000 square meters of hospital property. After the system had been in operation for one year, a saving of $127,000 was recorded, of which $87,000 was related to food expenditures and $40,000 to medication expenditures. However, a network engineer was hired for $50,000 a year, an additional $10,000 was spent for annual maintenance insurance, and an annual increment of $32,000 for equipment has been estimated. Thus net operational savings are $35,000 a year, and a return on the investment is expected within 11.4 years.

The costs of human resources were not calculated, because the hospital is a government institution that does not have the option of downsizing. It may be possible for a private institution to realize additional savings by reducing the use of secretarial services by 25 percent. Reduced human error and an increase in the number of online expert consultations are likely to result in lower litigation costs, which should hasten the return on the investment.

Security and confidentiality issues related to the computerized patient information system are covered by Israeli law. All computers with the system installed are located in offices that have bars on the windows and are locked when not being used. For protection against unauthorized access to confidential information, these computers do not have modems and are not linked with any external networks. User names and passwords enable graded access to confidential files by different staff members.

User-friendliness, the personal involvement of the hospital's director, and hands-on experience have been crucial to the successful implementation and acceptance of the computerized patient information system. The system can be adapted and upgraded to meet changing needs. Given the economic and patient care advantages of using a computerized patient information system, it is difficult to understand why such systems are not more common in public and private psychiatric institutions.

The authors are affiliated with the Institute of Psychiatric Studies of Sha'ar Menashe Mental Health Center, Mobile Post Hefer 38814, Israel (e-mail, shrmodai@matat.health.gov.il). Dr. Modai, Dr. Ritsner, and Dr. Silver are also with the Bruce Rappaport Faculty of Medicine, Technion, in Haifa, Israel.

Dudman J: Electronic patient records: facts at their fingertips. Health Service Journal 110(5728 suppl):9,10,113,  2000
 
Dugas M, Uberla K: MediDOK: an Intranet tool for XML-based data modelling in medicine. Studies in Health Technology and Informatics 22:983-987,  2000
 
Espinosa A: Implementing an ICU-CIS integrated to an HIS in Latin America. Studies in Health Technology and Informatics 77:916-920,  2000
[PubMed]
 
Greemes DS, Fleisher GR, Kohane I: Potential impact of a computerized system to report late-arriving laboratory results in the emergency department. Pediatric Emergency Care 16:313-315,  2000
[PubMed]
[CrossRef]
 
Knaup P, Mludek V, Wiedemann T, et al: Integrating specialized application systems into hospital information systems: obstacles and factors for success. Studies in Health Technology and Informatics 77:890-894,  2000
[PubMed]
 
Modai I, Rabinowitz J: Why and how to establish a computerized system for psychiatric case records. Hospital and Community Psychiatry 44:1091-1095,  1993
[PubMed]
 
Modai I, Sigler M, Kurs R: The computerized lab alert system for patient management in clinical care. Psychiatric Services 50:869-870,885,  1999
[PubMed]
 
Modai I, Sigler M: A computerized laboratory alerting system in a psychogeriatric unit. MD Computing 15:95-99,  1998
[PubMed]
 
Noffsinger R, Chin S: Improving the delivery of care and reducing healthcare costs with the digitization of information. Journal of Healthcare Information Management 14:23-30,  2000
[PubMed]
 
Modai I, Valevski A: Computerized patient information system in a psychiatric unit: five-year experience. Journal of Medical Systems 17:309-316,  1993
[PubMed]
[CrossRef]
 
+

References

Dudman J: Electronic patient records: facts at their fingertips. Health Service Journal 110(5728 suppl):9,10,113,  2000
 
Dugas M, Uberla K: MediDOK: an Intranet tool for XML-based data modelling in medicine. Studies in Health Technology and Informatics 22:983-987,  2000
 
Espinosa A: Implementing an ICU-CIS integrated to an HIS in Latin America. Studies in Health Technology and Informatics 77:916-920,  2000
[PubMed]
 
Greemes DS, Fleisher GR, Kohane I: Potential impact of a computerized system to report late-arriving laboratory results in the emergency department. Pediatric Emergency Care 16:313-315,  2000
[PubMed]
[CrossRef]
 
Knaup P, Mludek V, Wiedemann T, et al: Integrating specialized application systems into hospital information systems: obstacles and factors for success. Studies in Health Technology and Informatics 77:890-894,  2000
[PubMed]
 
Modai I, Rabinowitz J: Why and how to establish a computerized system for psychiatric case records. Hospital and Community Psychiatry 44:1091-1095,  1993
[PubMed]
 
Modai I, Sigler M, Kurs R: The computerized lab alert system for patient management in clinical care. Psychiatric Services 50:869-870,885,  1999
[PubMed]
 
Modai I, Sigler M: A computerized laboratory alerting system in a psychogeriatric unit. MD Computing 15:95-99,  1998
[PubMed]
 
Noffsinger R, Chin S: Improving the delivery of care and reducing healthcare costs with the digitization of information. Journal of Healthcare Information Management 14:23-30,  2000
[PubMed]
 
Modai I, Valevski A: Computerized patient information system in a psychiatric unit: five-year experience. Journal of Medical Systems 17:309-316,  1993
[PubMed]
[CrossRef]
 
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