The number of hospital employees with an engineering background is limited. For the electrical engineer who is involved in the implementation of a hospital information system, hospital-based technical support may include an information systems department and a clinical engineering (or biomedical engineering) department. The following aspects of the healthcare delivery system are worthy of study by an electrical engineer working in the clinical environment: The healthcare delivery system in the United States Williams and Torrens, 1984 The organizational structure of hospitals[Goldberg and Buttaro, 1990] The characteristics of hospital information systems [Austin, 1988; Minard, 1991] With this background information the electrical engineer will be better prepared to translate the concerns of hospital administrators and clinicians into the technical specifications of the hospital information system Healthcare Codes and Standards The healthcare delivery system is a highly regulated industry. Numerous governmental and nongovernmental organizations have established codes and standards intended to promote safe and effective patient care. although there can be significant differences in the regulatory environment from one hospital to another, the major codes and standards are relatively uniform The National Electrical Code(NFPA 70), promulgated by the National Fire Protection Association(NFPA Quincy, Massachusetts)applies to hospitals. Specifically, Article 517 deals with "Health Care Facilities. A more cused document, however, is the Standard for Health Care Facilities(NFPA 99). The most accessible format for this information is the NFPas Health Care Facilities Handbook Klein, 1990 which includes the full text of NFPA 99 as well as interpretive and explanatory material. Many of the healthcare-related provisions of the electrical code are based on two concerns. First, many patients in surgery and intensive care depend on electrical equipment for life support. Such equipment ranges from heart-lung bypass devices to mechanical ventilators. Therefore, much attention is devoted to ensuring the availability of electrical power in the event that the primary power distribution system fails. a hospital infor mation system that provides life-support functions may be subject to these provisions Second, because of the use of invasive medical procedures, many patients are considered to be electrically susceptible. Under certain conditions, electrical currents on the order of microamperes can cause ventricular orillation, a potentially fatal disruption of normal cardiac function. Therefore, the NFPA and other organi zations have established strict standards for grounding, "leakage"current, and other electrical parameters. These standards apply to devices and cabling in patient-care locations of the hospital. The Joint Commission on Accreditation of Healthcare Organizations( Chicago, Illinois)is another major source of standards affecting hospitals. The JCAHO's Accreditation Manual for Hospitals [JCAHO, 1993]covers the entire spectrum of hospital activities. Pursuit of JCAHO accreditation is voluntary but, in practice, essentially all hospitals seek accreditation to ensure eligibility for reimbursement under certain governmental programs At present, JCAHO standards include little reference to information systems. However, this is expected to change and, therefore, familiarity with the latest edition of the Accreditation Manual for Hospitals is advisable Another standard unique to the healthcare system is Health Level 7(HL7) which is a data communications protocol intended to facilitate the interfacing of various components in a hospital information system Walker, 1989]. These components range from accounting systems(financial data)to clinical laboratory information systems(laboratory test results)to medical records systems(documentation of patient care services)to patient data management systems(physiological data). In the recent past, each such component was independent and generally incompatible with other components. However, to achieve high quality in patient care at the lowest cost, both administrators and clinicians need integrated, comprehensive access to a wide variety of information HL is an attempt to specify the types of data(and their formats)to be shared within a hospital information system. For example, if all components of the system use a common format for a patient's name, then possible for a single database query to gather all data regarding that patient. This also allows automation of certain activities such as billing(through the accounting system) for laboratory tests ordered by clinicians (through the clinical laboratory system). Unfortunately, HL7 has not achieved its promise but it does represent a significant step away from the chaotic past[Bond et al, 1990] e 2000 by CRC Press LLC© 2000 by CRC Press LLC The number of hospital employees with an engineering background is limited. For the electrical engineer who is involved in the implementation of a hospital information system, hospital-based technical support may include an information systems department and a clinical engineering (or biomedical engineering) department. The following aspects of the healthcare delivery system are worthy of study by an electrical engineer working in the clinical environment: • The healthcare delivery system in the United States [Williams and Torrens, 1984] • The organizational structure of hospitals [Goldberg and Buttaro, 1990] • The characteristics of hospital information systems [Austin, 1988; Minard, 1991] With this background information the electrical engineer will be better prepared to translate the concerns of hospital administrators and clinicians into the technical specifications of the hospital information system. Healthcare Codes and Standards The healthcare delivery system is a highly regulated industry. Numerous governmental and nongovernmental organizations have established codes and standards intended to promote safe and effective patient care.Although there can be significant differences in the regulatory environment from one hospital to another, the major codes and standards are relatively uniform. The National Electrical Code (NFPA 70), promulgated by the National Fire Protection Association (NFPA: Quincy, Massachusetts) applies to hospitals. Specifically, Article 517 deals with “Health Care Facilities.” A more focused document, however, is the Standard for Health Care Facilities (NFPA 99). The most accessible format for this information is the NFPA’s Health Care Facilities Handbook [Klein, 1990] which includes the full text of NFPA 99 as well as interpretive and explanatory material. Many of the healthcare-related provisions of the electrical code are based on two concerns. First, many patients in surgery and intensive care depend on electrical equipment for life support. Such equipment ranges from heart-lung bypass devices to mechanical ventilators. Therefore, much attention is devoted to ensuring the availability of electrical power in the event that the primary power distribution system fails. A hospital infor￾mation system that provides life-support functions may be subject to these provisions. Second, because of the use of invasive medical procedures, many patients are considered to be “electrically susceptible.” Under certain conditions, electrical currents on the order of microamperes can cause ventricular fibrillation, a potentially fatal disruption of normal cardiac function. Therefore, the NFPA and other organi￾zations have established strict standards for grounding, “leakage” current, and other electrical parameters. These standards apply to devices and cabling in patient-care locations of the hospital. The Joint Commission on Accreditation of Healthcare Organizations (Chicago, Illinois) is another major source of standards affecting hospitals. The JCAHO’s Accreditation Manual for Hospitals [JCAHO, 1993] covers the entire spectrum of hospital activities. Pursuit of JCAHO accreditation is voluntary but, in practice, essentially all hospitals seek accreditation to ensure eligibility for reimbursement under certain governmental programs. At present, JCAHO standards include little reference to information systems. However, this is expected to change and, therefore, familiarity with the latest edition of the Accreditation Manual for Hospitals is advisable. Another standard unique to the healthcare system is Health Level 7 (HL7) which is a data communications protocol intended to facilitate the interfacing of various components in a hospital information system [Walker, 1989]. These components range from accounting systems (financial data) to clinical laboratory information systems (laboratory test results) to medical records systems (documentation of patient care services) to patient data management systems (physiological data). In the recent past, each such component was independent and generally incompatible with other components. However, to achieve high quality in patient care at the lowest cost, both administrators and clinicians need integrated, comprehensive access to a wide variety of information. HL7 is an attempt to specify the types of data (and their formats) to be shared within a hospital information system. For example, if all components of the system use a common format for a patient’s name, then it is possible for a single database query to gather all data regarding that patient. This also allows automation of certain activities such as billing (through the accounting system) for laboratory tests ordered by clinicians (through the clinical laboratory system). Unfortunately, HL7 has not achieved its promise but it does represent a significant step away from the chaotic past [Bond et al., 1990]