title: Building a comprehensive clinical information system from components. The approach at Intermountain Health Care.
abstract: OBJECTIVE
  To discuss the advantages and disadvantages of an interfaced approach to clinical information systems architecture.
  
  
  METHODS
  After many years of internally building almost all components of a hospital clinical information system (HELP) at Intermountain Health Care, we changed our architectural approach as we chose to encompass ambulatory as well as acute care. We now seek to interface applications from a variety of sources (including some that we build ourselves) to a clinical data repository that contains a longitudinal electronic patient record.
  
  
  RESULTS
  We have a total of 820 instances of interfaces to 51 different applications. We process nearly 2 million transactions per day via our interface engine and feel that the reliability of the approach is acceptable. Interface costs constitute about four percent of our total information systems budget. The clinical database currently contains records for 1.45 m patients and the response time for a query is 0.19 sec.
  
  
  CONCLUSIONS
  Based upon our experience with both integrated (monolithic) and interfaced approaches, we conclude that for those with the expertise and resources to do so, the interfaced approach offers an attractive alternative to systems provided by a single vendor. We expect the advantages of this approach to increase as the costs of interfaces are reduced in the future as standards for vocabulary and messaging become increasingly mature and functional.
authors.affiliation: Intermountain Health Care, University of Utah, USA. copclayt@ihc.com
authors.forename: P D
authors.initials: PD
authors.lastname: Clayton
authors.forename: S P
authors.initials: SP
authors.lastname: Narus
authors.forename: S M
authors.initials: SM
authors.lastname: Huff
authors.forename: T A
authors.initials: TA
authors.lastname: Pryor
authors.forename: P J
authors.initials: PJ
authors.lastname: Haug
authors.forename: T
authors.initials: T
authors.lastname: Larkin
authors.forename: S
authors.initials: S
authors.lastname: Matney
authors.forename: R S
authors.initials: RS
authors.lastname: Evans
authors.forename: B H
authors.initials: BH
authors.lastname: Rocha
authors.forename: W A
authors.initials: WA
authors.lastname: Bowes
authors.forename: F T
authors.initials: FT
authors.lastname: Holston
authors.forename: M L
authors.initials: ML
authors.lastname: Gundersen
mesh_terms: D003199:Computer Systems; D007256:Information Systems; D018511:Systems Integration; D014589:Utah