Ricerca>Progetti>HISS - Hospital Information System for Students

Project Title
HISS - Hospital Information System for Students


Results of the project


BACKGROUND

Technology vision
We are aware that mobile technology in our campus can improve dramatically the University Hospital activities. The strong need of a pervasive Hospital Information System encounters some difficulties in the diffusion of PC's in the wards or in other places. Computers are still too big to be installed in the place where the nurse or the physician works. The most common tool for a medical operator is still the exercise book and the pen.
By giving ubiquitous access to digital medical resources, all the personnel could be able to cure better and faster the patients.
We have already started working in the field and our level of deployment of mobile technology on the scale provided is 2.

Mobile technology plans
Wireless LAN technology in "Campus Bio-Medico" University of Rome has been used for experimental purposes for one year. Eventually, in March 2003, one ward of our University Hospital has been fully equipped with a WLAN system to allow nurses to access and modify clinical data of the patients. The most important application, so far, is the drugs administration recording which has a strong economic impact in the institution. A better management can lead to global savings while avoiding mistakes and waste.
We have implemented the WLAN solution on Symbol technology because they provide rugged palm computers (droppable, waterproof, robust) with built-in bar-code reader and strong cryptography.

Mobile technology implementation
The main step for the future is to install all over the Hospital a suitable support for accessing the Hospital Information System using any wireless computer. One main point is security (cryptography and authentication). After examining different technologies (very often not interoperable) we concluded that we have to wait some more time to have a standard, non-proprietary, strong and stable system.
That's why we have decided to concentrate our task on the software production, having experienced how different is to design an interface for a 15" monitor opposed to a small palm display with no keyboard. The recent challenge of Tablet PC's opens another interesting field of researching.
In the mean while we plan to implement wireless access in all the wards and some classrooms for teaching purposes.

Other Projects
Prof. G. Iannello and others are involved in Italian and European research projects on advanced distributed service on a wired-wireless infrastructure.
Distance learning projects have been developed in our University in a joint venture with ELIS, a vocational training school in Rome, leader in the e-learning field in Italy. We are producing video based lessons for nurses with the goal of having them also available (streaming, without downloading) on portable computers. Even though the main goal of these recording is to address external nurses giving out our know-how in the field (we were the first Italian University running the Nursing Diploma and now the Laurea), we feel that the same content can be useful for our continuous education programs. We imagine that a nurse in a ward, during a relatively calm period (such as a night turn) can easily access, using her palm computer, the video on demand library of lessons.
Campus Bio-Medico University has also produced video based tutorials for the VAKHUM project, funded by the European Commission, dealing with 3D kinematics of the human bones.

Synergy
The grant we are applying for can sensibly shorten the time for achieving our final goal. The diffusion of mobile devices will surely lead us to new forms of accessing clinical data. The experience gathered will give us important hints on the best interface and the most critical applications.

PROPOSAL OVERVIEW

Executive summary
Students of Medicine and Nursing, as well as Dietetics and Bioengineering will find at the end of their University course a different environment in hospitals: more informatics, more telecommunication and more wireless technology. There is a urgent need of training in this field, in order to discover the new capabilities of the "connected hospital". This proposal is to set up a simulation of a Hospital Information System in our University Clinic, mainly used by the students through wireless devices (mainly palm and tablet computers). The coexistence of a Faculty of Medicine and Bioengineering in the same institution and building, gives a good chance of enhancing cooperation among the students using mobile technologies. Each group of students will have a specific role. Bioengineering students will be in charge of setting up software and hardware, evaluate performance, monitor activity and study interoperability issues. Medicine students will focus on the clinical information required at the bedside. Nursing students will work on the nursing record. Dietetics students will address the communication between wards and catering department. The project will be coordinated by prof. Giulio Iannello, full professor of Informatics, with the help of the Information Technology departments of the University and Hospital.

Project details
Hospitals are enhancing their level of technology. The complexity of modern care requires an integration of hardware and software. One of the weakest points in distributing the access to electronic medical records is the difficulty of having computers in the wards or in the patients' rooms. Researchers have studied the failure of using PC's or notebooks placed in the trolley of the nurse: it seems that the time and the attention to typewrite data is taken from the direct care of the patient and therefore acceptance by the nurses is low. Better and simpler interfaces are required, but also a less invasive instrument. Moreover, the need of plugging the notebook to the Hospital network to work on-line and access the latest data, makes it more uncomfortable. The advent of wireless computing and small devices can change dramatically this scenario.
The introduction of these new modes requires careful study and tests. We think that the best way is starting with a simulated Hospital Information System, developed by the students of Bioengineering and used by the students of Medicine, Nursing and Dietetics.
The impact of this simulated HIS is strong on all the actors. The project of the database structure falls under the Clinical Information Systems course of the Bioengineering Laurea. Bioengineering students of the Telematics course will deal with performance evaluation, monitoring, security issues and interoperability specifications. Vertical roaming (Bluetooth vs. WLAN and UMTS/GPRS vs. WLAN) will also be studied in conjunction with ELIS Vivai d'impresa which has already developed specific test beds. The compatibility for future incorporation of the wireless devices in the Hospital Information System will be studied by the Information Technology Department of the Hospital, addressing especially the security issues (finger print authentication, VPN, etc.)
The construction of an order entry system for diets is a topic dealt by the students of the Dietetics curriculum. Nursing and Medicine students will work mainly with the electronic clinical records.
In order to achieve a valuable result in a short time (one year) the HIS will be restricted to the clinical information, leaving aside all the administrative modules (admission, billing, etc.) and some specialized areas (radiology, laboratory, etc.). In fact, the clinical information is mostly used while visiting a patient in a room and seems suitable for presentation on a small display.
We plan to test also tablet computers in order to understand whether the absence of a keyboard and the more natural way of taking notes using a pen can be more acceptable for a nurse at the bedside.
The use of digital cameras for clinical illustration of patients (e.g. dermatology problems, state of a wound, etc.) with immediate delivery to the HIS will also be addressed.
In all the wards and rooms there will be a wireless connection to a specific LAN (different form the actual hospital information system LAN, for security reasons). Each student participating in the project will be equipped with a wireless enabled iPAQ with a biometrics device for authentication. Some of them, especially the teachers (nurses and physicians) will use tablet PCs. We estimate the involvement of one hundred students, on a shared basis for the use of around 40 wireless devices.
An important point is feedback. A system for collecting comments, bug notices, proposals and other information from the users, will be set up.
We plan to set up the whole network with multicast mode enabled. This will give us the possibility of transmitting to many students at the same time video based content (e.g. live from the operating theatre or from a lecture hall). A video server will therefore be set up, choosing the appropriate standard compatible with the wireless portable devices (MPEG-4, Window Media, Real Video).
The HISS project therefore requires a tight collaboration of all the departments involved in order to grow in a parallel way.

Milestones