Brigham Integrated Computing System (BICS)
The Brigham Integrated Computing System (BICS) is an electronic medical record system for the Brigham & Women's Physician Hospital Organization (BWPHO), an organization of more 700 outside clinics distributed around the greater Boston area. (Sittig et al., 1999).
The Brigham Integrated Computing System (BICS) originated as a part of the Beth Israel Hospital (Center for Clinical Computing) Meditech Interpretive Information System (MIIS) in 1984. Brigham and Women’s Hospital (BWH) started working on independent development off of BICS since 1988 to support BWH’s continued expansion (Teich).
The Brigham integrated computing system (BICS) provides nearly all clinical, administrative, and financial computing services to Brigham and Women's Hospital, an academic tertiary-care hospital in Boston. The BICS clinical information system includes a very wide range of data and applications, including results review, longitudinal medical records, provider order entry, critical pathway management, operating-room dynamic scheduling, critical-event detection and altering, dynamic coverage lists, automated inpatient summaries, and an online reference library. BICS design emphasizes direct physician interaction and extensive clinical decision support. Impact studies have demonstrated significant value of the system in preventing adverse events and in saving costs, particularly for medications.
BICS was created using the MUMPS and HYPER-M for the graphical user interface, and is designed to assist in clinical, administrative, and financial services (Sittig et al., 1999). Its applications support direct physician order entry, scheduling operations, critical event detection, and most importantly clinical decision support (Teich et al., 1999).
As part of BICS, major clinical systems and subsystems developed at BWH include the following:
- Ambulatory Medical Record
- Physician Order Entry
- Event Engine (processing logic to detect unusual patterns in data flowing into BICS and to generate appropriate alerts)
- Handbook System
- Sign-Out System
- Coverage List (Teich).
The initial focus of development was to create a new client-server technical platform that would support the hospital's continuing expansion and provide the processing power and scaleability needed for future developments (Teich, et al. 1999). A secondary focus was to change the role of computers in healthcare by creating new clinical informations systems.
In year 1999, a study was performed to determine whether the time required to initiate a referral decreased using the BICS email referral system versus the traditional paperwork. The results showed that the process was shorter using BICS emailing, proving the efficiency and productivity of this system (Sittig et al., 1999).
Clinical System Design and Function
- Broad Content
- Workflow Support
- Clinical Decision Support: includes
- Order Entry
- Added Value
(Teich et al., 1999)
BICS uses a window interface for Physician Order Entry. Screens are designed strategically for medication alerts and reminders combining medications and the last laboratory test results. Order entry are used widespread throughout the office for every patient and can be access within the program software. (Teich et al., 1999)
Clinical Decision Support
CDSS provides a way to modify any orders that are entered to better the quality of care. The suggestion is given to the provider with the option to override it, however it must be signed by the physician before the order is released. (Teich et al., 1999)
- Teich, JM, Glaser JP, Beckley RF, et al. The Brigham integrated computing system (BICS): advanced clinical systems in an academic hospital environment. Int J Med Inform. 1999; 54(3):197-208
- D. F. Sittig, G. J. Kuperman, and J. Fiskio. Evaluating physician satisfaction regarding user interactions with an electronic medical record system.Proc AMIA Symp. 1999; 400–404
- Jonathan M.Teich. Advanced Clinical System in a Hospital Environment: The Brigham Integrated Computing Systems (BICS).PubMed Central. Proc Annu Symp Comput Appl Med Care. 1995; 1024. PMCID: PMC2579875
- Brigham and Women's Hospital, Boston, MA 02115, USA.
International Journal of Medical Informatics (Impact Factor: 2.72). 07/1999; 54(3):197-208. DOI: 10.1016/S1386-5056(99)00007-6 Source: PubMed http://www.researchgate.net/publication/12893283_The_Brigham_integrated_computing_system_(BICS)_Advanced_clinical_systems_in_an_academic_hospital_environment