Ancillary Systems
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An ancillary system usually refers to software applications used by patient care support departments such as laboratory, radiology, and pharmacy. Other departments such as cardiology, respiratory, physical therapy, and material management may have their own software applications as well. LISs and radiology information systems (RISs) were available long before the concept of EHR systems was introduced. Both LISs and RISs are designed to address the specific needs of the department related to collecting, processing, and reporting test results along with managing resources and costs. The LIS consists of several components related to the laboratory subdepartments, including hematology, chemistry, microbiology, blood bank, and pathology. The LIS may also interface with other devices, such as blood analyzers, for direct input of blood test results. Coding structures are used to track and identify resources and provide cost data for billing. Logical Observation Identifier Names and Codes (LOINC) is a universal coding system used to identify laboratory and other clinical observations, whereas the Systematized Nomenclature of Medicine (SNOMED) coding structure is commonly used in pathology. These standard languages are discussed in more detail in Chapter 22.
The RIS is similar to the LIS in that it incorporates data from multiple services that include X- rays, fluoroscopy, mammography, ultrasound, magnetic resonance imaging (MRI) scans, computed tomography (CT) scans, and other special procedures. It also uses coding structures such as Current Procedural Terminology (CPT) or International Classification of Diseases (ICD) to identify procedures, resources, and billing. However, the global standard for the transmission, storage, and display of medical imaging information is Digital Imaging and Communications in Medicine (DICOM). The RIS may integrate data from a picture archiving and communication system (PACS), which stores digital versions of diagnostic images for display in the EHR.
The pharmacy department typically has a system to assist with inventory, prescription management, billing, and dispensing of medications. The FDA requires that all drugs be registered and reported using a National Drug Code (NDC). The NDC and SNOMED C axis are examples of coding structures that would be used in a pharmacy system. RxNorm is another standard mandated by the Office of the National Coordinator for Health related to MU reporting and data exchange. Clinical screening can be done by monitoring medication usage throughout the hospital and identifying potential adverse drug events. Prescriptions can be tracked along with printing of labels and medication instructions for patients or staff. The pharmacy system can provide patient drug profiles that include current and past medications, allergies, and contraindications. These features are designed to enhance patient safety. A closed-loop medication management system connects the pharmacy system to the CPOE, eMAR, and bar coding systems.