Part I: Overview of Hospital Information Systems The first part of the course introduces the major modules of hospital information systems and their functions, including the Electronic Medical Record system (EMR), Picture Archiving and Communication System (PACS), Hospital Information System (HIS), Laboratory Information System (LIS), medication management systems, and Clinical Decision Support Systems (CDSS). The EMR focuses on comprehensive management of patient information, including medical histories, examination records, and treatment plans. PACS is designed for the storage, retrieval, and sharing of medical images, enabling physicians to quickly access imaging data. The HIS provides core administrative and operational functions such as patient registration, appointment scheduling, financial processing, and administrative management. This section also examines leading global healthcare system vendors, including Epic Systems, Cerner, Allscripts, and Meditech, with detailed discussions of their design features in interoperability, information security, and user interface design. Part II: Hospital Operational Workflows The second part focuses on operational workflows within hospitals, particularly the functioning of emergency department systems. Using the emergency department system of National Taiwan University Hospital as a case study, the course demonstrates how patient registration, triage, diagnostic testing, and clinical evaluation are efficiently managed. This section also covers inpatient and outpatient workflows, describing processes such as admission management, bed allocation, clinical documentation, and discharge procedures. In addition, the Director of the Information Department at National Taiwan University Hospital is invited to share practical experiences, challenges, and insights from developing and implementing medical information systems. Part III: Laboratory Data Standardization and Applications The third part focuses on laboratory data standardization and its practical applications. It introduces the origins of LOINC and its importance in global laboratory data exchange. Students learn how LOINC codes are implemented within LIS to ensure interoperability between different systems. Hands-on exercises are included to allow students to practice LOINC coding and deepen their understanding. A laboratory expert is also invited to share practical experiences in applying LOINC in routine laboratory operations. Part IV: Standardization of Medical Terminology and Text Transformation The fourth part addresses the standardization of medical terminology and the transformation of clinical text into structured data. It provides an in-depth analysis of the structure of SNOMED CT and its role in improving data standardization within EMR systems. Practical exercises teach students how to convert clinical narratives into SNOMED CT codes. The course also demonstrates how large language models can be used for automated terminology mapping. Students will use specialized transformation tools to understand both the capabilities and limitations of automated coding. Part V: International Drug Coding and Taiwan’s Implementation Strategy The fifth part focuses on international drug coding standards and Taiwan’s implementation strategy. It introduces the background of RxNorm and its applications both internationally and in Taiwan. The relationships between RxNorm, ATC classification, and Taiwan’s National Health Insurance (NHI) drug codes are also explained. Students will practice RxNorm coding using tools developed at the national level, allowing them to experience the process of drug information standardization firsthand. Part VI: Clinical Quality Management and Rule Languages The sixth part explores clinical quality management and rule-based languages used in decision support systems. It introduces the concepts of Clinical Quality Language (CQL) and CDS Hooks and explains their importance in clinical decision support. Students will learn how to write CQL rules and simulate CDS Hooks applications. For the midterm project, students are required to present their CQL rules and demonstrate how they are applied through simulated CDS Hook scenarios. Part VII: Advanced Topics and Course Integration The final part addresses advanced topics and provides a comprehensive integration of the course content. It introduces the architecture of SMART on FHIR and includes hands-on exercises for students. The course also discusses Taiwan Core Implementation Guide (Taiwan Core IG) and data governance principles, comparing them with international regulations such as GDPR and HIPAA. In addition, this section highlights cybersecurity technologies in EMR systems and ethical issues related to health data sharing. Finally, the course presents the development of Taiwan’s smart healthcare ecosystem, including the establishment of three national medical AI centers and their potential impact on the future of healthcare. The course concludes by equipping students with a comprehensive understanding of medical information systems and practical implementation skills, enabling them to apply modern technologies and interoperability standards across diverse healthcare environments. Class Time: Friday 10:20 AM – 12:30 PM Classroom: Room 111, Computer Science and Information Engineering Building. 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Hospital information systems can be considered the central nervous system of hospital operations. In the past, most hospitals developed their own customized systems tailored to their specific operational needs. While these systems often functioned well within individual institutions, they created significant limitations in the era of smart healthcare. Because these systems were built independently and were largely incompatible with one another, it became difficult to aggregate sufficient large-scale data to support the development and training of artificial intelligence. Patient data could not easily be exchanged across systems, and medical applications could not run consistently across different platforms. As a result, it was difficult to build a robust ecosystem of healthcare applications. The fragmentation of information systems not only weakens overall competitiveness but also seriously compromises the safety of continuity of patient care. Recognizing this challenge, the United States began promoting the 21st Century Cures Act in 2016. After five years of research and policy development, the relevant regulations were formally implemented in 2022. These regulations require that all electronic health record (EHR) systems support and use the FHIR (Fast Healthcare Interoperability Resources) standard. In addition, all healthcare applications must follow the SMART on FHIR framework as the unified standard for interoperability. Since the implementation of this law in 2022, EHR systems that fail to adopt these standards may be considered non-compliant with federal regulations. The policy has triggered a large-scale transformation, prompting healthcare systems around the world to modernize their infrastructure and adopt emerging interoperability technologies. The objective of this course is to introduce the fundamental principles of electronic medical records, their key components, the applications of the FHIR standard, and the SMART on FHIR framework. The course will also incorporate Taiwan’s ongoing next-generation electronic medical record initiatives and policy programs as teaching materials. Through these examples, students will gain an understanding of the latest developments in Taiwan and develop the ability to work within this system architecture. Ultimately, the course aims to cultivate professionals capable of supporting and advancing the modern healthcare application ecosystem.

The course evaluation consists of several important components. First, class attendance is an essential requirement. Attendance will directly affect the final grade, as full participation in lectures, discussions, and learning activities is critical to achieving effective interactive learning. Second, midterm and final presentations constitute major evaluation components of the course. Students will complete these assignments in groups, with topics assigned by the instructor. The topics will focus on key issues related to hospital information systems. Each presentation should demonstrate depth, completeness, and clear analytical thinking, reflecting thorough research and understanding of the subject matter. In addition, each group project must include either a system design proposal or a simple programming implementation related to the topic, allowing students to demonstrate their practical application skills. Every group member is required to clearly explain their individual responsibilities and contributions to the project. This helps the instructor evaluate each member’s level of participation and ensures fair allocation of individual grades. Teamwork performance is also part of the grading criteria. The overall performance of the group will influence each member’s grade; however, the instructor may adjust individual scores based on each student’s actual contribution in order to maintain fairness. The course adopts a hybrid teaching format, combining in-person and online sessions depending on the instructor’s arrangements. When the instructor schedules special sessions or invites international speakers, the class may be conducted online. In addition, some guest speakers may choose to deliver lectures remotely due to travel or scheduling constraints. This arrangement allows students to interact with international experts and broaden their perspectives. All hands-on practical sessions will be conducted in person to ensure that students receive immediate technical guidance and support. These practical components are designed to provide sufficient training opportunities and strengthen students’ understanding and ability to apply the course content. Overall, this hybrid teaching model maintains a high-quality learning experience while also providing flexibility to accommodate different circumstances and learning opportunities.

4-8 hours

Textbooks Benson, Tim, and Grahame Grieve. Principles of Health Interoperability: FHIR, HL7 and SNOMED CT. 4th ed., Springer, 2021. ISBN-10: 3030568822 ISBN-13: 978-3030568825. Braunstein, Mark L. Health Informatics on FHIR: How HL7’s API is Transforming Healthcare. 2nd ed., Springer, 2022. ISBN-10: 303091562X ISBN-13: 978-3030915629. Reference U.S. Department of Health and Human Services. Interoperability. https://www.healthit.gov/topic/interoperability .

Useful website HL7 https://www.hl7.org/index.cfm ONC https://www.healthit.gov/topic/interoperability/standards-and-technology SNOMED https://www.snomed.org/ LOINC https://loinc.org/ RxNorm https://www.nlm.nih.gov/research/umls/rxnorm/index.html 衛生福利部資訊處 https://aicenter.mohw.gov.tw/AC/mp-208.htm Blog https://blog.mohw.gov.tw/ Videos ONC tech forum Others Dr. Lee’s Textbook on Modern EHR