Lonnie Blevins

The Regenstrief Medical Record System: a quarter century experience

Entrusted with the records for more than 1.5 million patients, the Regenstrief Medical Record System (RMRS) has evolved into a fast and comprehensive data repository used extensively at three hospitals on the Indiana University Medical Center campus and more than 30 Indianapolis clinics. The RMRS routinely captures laboratory results, narrative reports, orders, medications, radiology reports, registration information, nursing assessments, vital signs, EKGs and other clinical data. In this paper, we describe the RMRS data model, file structures and architecture, as well as recent necessary changes to these as we coordinate a collaborative effort among all major Indianapolis hospital systems, improving patient care by capturing city-wide laboratory and encounter data. We believe that our success represents persistent efforts to build interfaces directly to multiple independent instruments and other data collection systems, using medical standards such as HL7, LOINC, and DICOM. Inpatient and outpatient order entry systems, instruments for visit notes and on-line questionnaires that replace hardcopy forms, and intelligent use of coded data entry supplement the RMRS. Physicians happily enter orders, problems, allergies, visit notes, and discharge summaries into our locally developed Gopher order entry system, as we provide them with convenient output forms, choice lists, defaults, templates, reminders, drug interaction information, charge information, and on-line articles and textbooks. To prepare for the future, we have begun wrapping our system in Web browser technology, testing voice dictation and understanding, and employing wireless technology.

Data base management, feedback control, and the Regenstrief Medical Record.

Because of the differences in informational needs among medical practices, medical record systems should be fiexible. The use of data base management and use-oriented command languages helps to achieve flexibility. The Regenstrief Medical Record System is based upon a data base management system and two user-oriented command languages (the RDB Command Language and CARE). Most batch reports, file maintenance procedures, and ad hoc retrievals can be specified by the user by means of these two languages. This means that the user can specify which reports he wants and how they should look. Daily on-line activities are performed by application programs. The data base system also provides flexibility to these programs since the content and format of many of the display screens are defined by statements that are similar to the command language statements and are stored within a text file. The Regenstrief Medical Record System now carries records for 60,000 patients.

The Benefits of Automated Medical Record Systems for Ambulatory Care

Our purpose is to describe the advantages of computer-stored medical record systems. Consequently, the focus is on what the computer record gives to the practice—the system’s outputs. We will illustrate the discussion with examples from different automated medical records (AMRs) for outpatient care, but this chapter is not a comprehensive review.

The regenstrief clinical laboratory system

The Regenstrief Clinical Laboratory System (RCLS) has been operational since 1975 at Wishard Memorial Hospital in Indianapolis, Indiana (a 580 bed facility). The clinician support, user interfaces, and use of a true data base management system distinguish this system from many commercially avaiIabIe laboratory systems. Physician reports include laboratory, clinic, pharmacy and radiology data in a single, compact flow sheet. The system can search patient medical records for conditions that may require corrective action and inform physicians of the reasons these actions should be considered. The site-specific modifications required to transport this system do not require re-programming. The system allows multiple specimen numbering sequences; identification of terms by name or number; unlimited amounts of free text; reports that can be tailored by non-programmer personnel; CAP accounting statistics; on-line instrument interfaces; and extensive on-line instructional facilities. The Regenstrief Clinical Laboratory System (RCLS) accomplishes most of the data capture, reporting and management functions expected of such systems, but it has a number of distinguishing features. These include: 1) its focus on usage by the clinician; 2) its accomodating user interface; 3) its roots in a true data base management system.