Homework: Architecture
                              
            (Introduction to Medical Informatics)
         (http://www.cpmc.columbia.edu/edu/textbook)

You have been hired as consultants for a small community
hospital. The hospital is going to build a relationship with
a local Health Maintenance Organization (HMO). The HMO
contracts with a company that sends nurses to patient's
homes. The HMO's goal is to reduce the cost of healthcare
while increasing access by allowing nurses to carry out
tasks that normally would be done by physicians.

In order to accomplish this, they want the nurses to have
access to the patient's clinical data, and they want the
nurses to be able to enter data into a clinical database.
Furthermore, the HMO wants to create a single bill for each
patient; the bill must include services and tests performed
in the hospital.

You are concerned with data for the following departments:
radiology, clinical laboratory, and pharmacy. The radiology
department has their own computer with a departmental
management system that keeps track of what X-rays have been
done, the clinical results, and the charges to patients. It
is currently used only within the department; physicians get
information via paper reports. The clinical laboratory has
an outdated system on their own computer, which was written
by a local programmer. They need to replace it to
accommodate larger volumes of data and new types of
laboratory tests. The pharmacy department has no computer
system at present.

Your job is to come up with a plan for getting data to the
nurses while they are in the home and allowing them to
record their observations of the patients. They need access
to the radiology data, clinical laboratory data, pharmacy
data, and data collected by nurses on previous visits. You
also need to send consolidated billing information from all
three departments to the HMO's central computer.

Assuming the nurses will be using some kind of portable
computers in the home, present a plan for the hospital. You
should address issues like the following:

  1.   will there be one central database or many
  2.   what will you build and what will you buy
  3.   how will you convince departments to follow your advice
       (what is in it for them)
  4.   describe the communications you will use among systems
       and with the portable devices
  5.   describe the hardware you will use
  6.   address vocabulary and data transfer protocols

You must work on the project in groups of 3 to 4 students.
It will be to your advantage to include students with
different skills (eg, computers and health care) in the same
group. On Monday 11/14/94, each group will spend 10 minutes
presenting their plan. On Monday 11/21/94, each group will
hand in a written report of no more than 3000 words (plus
any diagrams they deem appropriate) describing their plan.