Table – 2
However, it was found that the manager disagree with the statement that the system of the hospital helps in discharging effectively their managerial responsibilities as well as in enhancing the inter and intra hospital communication. He agrees that the statistical information from the departments helps in decision-making. He also agrees that the existing system does not help in the Quality Assurance Program (QAP) as well as in enhancing the functions of the supportive services and that the present system does not help as a tool in the various utilization processes.
Majority of the doctors do not believe that the existing system can help reduce the cost of patient care or shorten the stay of the patient in the hospital.
Table – 3
The majority of the doctors feel that the nonexistence of ward computers is a hindrance in providing the expected patient care. They also feel that the existing system does not help either in making the OPD consultations quicker or in generating quick laboratory reports.
2.1.3 Key Findings:
Present study reveals, the existing system requires up gradation to meet the requirements of the managers and the clinicians. Participants feel information system in a hospital assists in decision making, medical audit and in various other important purposes. Participants felt that the existing system resulted in longer time for consultation and delay in investigation results. Majority of the participants feel that the system can help in education and research if developed in an appropriate approach.
2.1.4 Probable Solutions:
Based on the key findings above we came up with the following solutions:
- Introduce an information system to record the information and case history of the patients.
- Introduce an information system that will coordinate the activities of various administrative departments
- Bring all the departments of the hospital under one umbrella by introducing a new unified intelligence system, which will provide clinicians and hospital administrators with customized, flexible, unified views and reports, enabling more informed and rapid analysis.
2.1.5 Feasibility Study:
In this section we will try to focus on the cost-benefit analysis of our probable solutions.
Among the three options the most easy-to-implement information system would certainly be option 1 and the most difficult one would be option 3. However, we have to take into our consideration that option 1 and 2 will only give us partial solutions to total problems of the hospital. The only solution that can help meet the major problems is option 3. Therefore, we would opt option 3 over the rest of the solutions.
The major objective of an information system is to make the total organizational process faster with more effectiveness and efficiency by reducing the dependence to human resource and concentrating more on using technological resource. The first two options can be implemented with less expenditure. However, these systems are not fully automated and therefore still requires a huge deal if manual labor within the system. On the contrary, if we implement option 3, we can reduce manual labor to 50% or even more. Although the initial cost of implementation would be huge, but it would pay off gradually since this system require less employees and can serve the patients more quickly than ever before. The benefits from this system can far outweigh its costs, and the project has higher priority than other projects that might use the same resources because the introduction of a better and efficient health care system has become the need of common people.
Option 1 and 2 will bring organizational changes to their respective departments. However, if we want to implement option 3, that will bring an excessive amount of change in the organizational process and the organization have to change rapidly to absorb the change, and the most important fact that we have to keep in mind that the system may not have enough support to be implemented successfully and the employees whose job will going to be under threat may resist the implementation of the system.
Now the summary of these studies can be presented in the table below:
Therefore, it would be better for the hospital if we go for option 3.
- Information System Plan:
In this section, we will focus on the information that we require the new system. For this purpose, we will have a department wise look for the information required and various tasks performed at these departments.
Clinicians work diligently to provide the highest-quality patient care in the most cost-effective manner. Multiple islands of information and different systems that do not talk to each other make it difficult for clinicians to get a consolidated view of data needed for patient care. As a result:
- Clinicians spend large amounts of time waiting on, or trying to locate, patient information.
- Alternatively, clinicians proceed with patient care before receiving a complete medical history, which can compromise the quality of care they are able to offer.
The new information system should be such that it:
- Increase accuracy
- Enhance efficiency
- Substantially reduce costs
- Standardization support with format-agnostic system
- Powerful image rendering, image manipulation and interfacing with third-party tools
Hospital financial administrators are faced with the challenge of providing better value while operating under increasingly tight budgets. The challenges that staff focused on financial operations face include:
- Clinical, financial and operational functions are increasingly becoming intricately tied together, requiring a need for data typically scattered across IT systems.
- Most financial analysis requires time-consuming manual compilation.
- Multiple systems must be accessed in order to understand key revenue drivers.
To help the researchers with their works, the new information system should:
- Substantially reduce the time required to test hypothesis on existing data.
- Provide a consolidated view of data needed to identify qualified patients for clinical trials, conduct research, or support studies.
- Access data aggregated across systems in order to monitor and track trends.
- Impact of Proposed Information System on various activities:
It is estimated that if our proposed information system is implemented within the organization, it can bring drastic change in the speed and efficiency within the different activities of the hospital. The table below presents only a tip of that iceberg:
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System Design
2.2.1 Overview of the new information system
The new system is going to be a unified intelligence system that provides the flexibility and agility to manage both current and future information needs. This helps the hospital to take a holistic and long-term approach towards an effective information strategy that supports organizational missions and goals.
Characteristics:
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Unified: Provide a single point of access to the wealth of information present in hospital.
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Flexible: An innovative approach to real-time data capture, storage and presentation will allow system to quickly deliver rich, role-based, customizable views and allows users to adapt the system to their own workflow, preferences and data requirements.
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Manageable: The system is designed from the inside out for simplified deployment and support, allowing for changes and organic evolution without added burden to the organization.
How the system will work:
The data structure and information flow within the system will specifically be designed to get the most value from constantly changing data. The system will work with the institution’s existing systems by making a copy of the data from those systems and saving it to its own store.
Once configured, the system provides clinicians and hospital administrators with customized, flexible, unified views and reports, enabling more informed and rapid analysis. The system provides quick access to all available data—text, charts, images, video, and transactional data—to anyone who needs to view it.
The system delivers a unique approach to:
- Data acquisition
- Data storage
- User viewing
Data Acquisition
The system takes an innovative approach to data acquisition by:
- Bringing together all structured or unstructured data stored within the organization very rapidly, with little or no impact on the existing systems.
- Capturing data available in any format or standard.
- Using parsers to break incoming messages into individual data elements, which are stored in the system data core.
Data Storage
Parsers store information in the Data Core into a structure that is easy for hospital IT administrators to interpret, audit, and use.
The historical archive stores messages forever, allowing users to:
- Extract additional information from previously received data
- Restructure the way information is stored for a different need or application
- Tweak and optimize the speed at which the data can be retrieved from storage
- Create a table exactly formatted to suit the needs of an external application
User Viewing
The system allows users, depending on their role and access privileges, to view in real time the data stored in the system through the powerful and intuitive Client.
The system Client allows users to interactively explore the information and aggregate it on the fly without requiring assistance from the IT staff. Users can see all of the data in logical cohorts, customized to suit their particular workflow.
A sample dialogue box is shown in the following:
2.2.2 Objectives of the system
The short-term objectives of the new information system are to reduce costs and improve the accuracy and timeliness of patient care, accounting and administration, record keeping, and management reporting. The long-term goal are to build and maintain a patient database for analysis of data to facilitate decision making process.
2.2.3 Scope of the system
As a prelude to computerization a comprehensive requirement analysis study was conducted to ascertain the various needs for computerization. Patient Care related areas were given priority in order to achieve the objectives.
2.2.4 The functions of new information system
New information system, the Unified Intelligence System, provides clinicians with:
- Real-time access to aggregated data for informed decision-making.
- Unique and customizable views for each patient with all associated key labs and surgical status
- The capability to drill down into each patient's medical history, including admission diagnosis, key indicators, labs, x-rays and other images.
The system can help clinical departments:
- Demonstrate compliance with core measures and other regulatory requirements.
- Reduce the time for physicians to track down patient-related data.
- Improve physician adoption of clinical solutions by reducing the complexity surrounding multiple user interfaces and log-ins.
- Maximize infection control through timely infection isolation and easy device tracking.
The new system offers financial administrators with:
- Access to all patient, financial, and operational data from across all hospital information systems in a single, unified database.
- The ability to bring together data from various systems and run what-if scenarios to uncover issues that may be creating a negative impact on the organizational bottom line.
The system can help finance departments:
- Gain a comprehensive view of clinical, financial, and operational information for more accurate reimbursement and billing of services.
- Understand how services or units contribute to the bottom line and identify areas for improvement.
- Reduce time required for analyzing and correlating data from multiple disparate systems.
Researchers need access to data that is often sequestered in homegrown or legacy information systems.
The system offers researchers the capability to:
- “Free” data typically captive in soloed systems, providing researchers a first step to extracting insights through clinical analysis.
- Identify and track patients who may be seeing multiple clinicians, and to monitor for specific trends across larger patient populations.
- Speed the iterative and investigative aspects of clinical research.
- Build and modify their own queries on-the-fly, without having to make special requests through the IT department or outside vendor.
New information system helps hospital administrative staff:
- Improve operational performance by delivering data required for continuous improvement.
- Correlate financial, clinical and administrative data to understand performance trends and its impact on the organization.
- Consolidate data across multiple hospitals in the system.
- Identify the trends and process issues within or between departments.
IT professionals deal with the ongoing technology demands of their organization, including large numbers of daily support requests for one-off reports.
The system is built on widely used and supported Microsoft products for reliability, scalability, supportability and security.
Scalability: Proven to handle large amounts of data and critical enterprise workloads, The system:
- Leverages Microsoft SQL Server 2005 scalability.
- Is designed to scale with consistently fast performance.
- Supports an unlimited number of interfaces and role-based views.
Supportability: The system can reduce IT resources required for data aggregation, integration, and reporting because it:
- Is easy to administer, configure, and deploy.
- Provides support for broader Microsoft platform management tools.
Security: The system provides a secure environment to help address privacy and compliance requirements, with:
- Role-based access controls and audits.
- Windows authentication and SQL Server 2005 security.
- Secure system access through Active Directory and LDAP.
- An application server built on IIS.
- Configurability with biometrics and smart cards.
The system helps IT departments:
- Integrate inflexible, independent architectures and legacy infrastructures on an ad hoc basis.
- Reduce time-consuming one-off requests for integration and reports that undermine productivity.
- Improve value received from existing IT investments by effectively leveraging captured data.
- Lower the cost and time required to add and use data in new ways.
- Minimize the complexity and interdependencies of managing point-to-point interfaces.
The system lets everyone involved in a patient’s care, including physicians, nurses, pharmacists, access the same information with the same view—so they’re all on the same page.
Because it is a true closed-loop system—built on the same platform, with modules and data designed expressly to work together—The Medication Management system:
- Allows information to flow smoothly so it can remain intact at each handoff
- Works intuitively with existing processes
- Enables complex care workflows and point-of-care support
- Facilitates more informed care for patients
The Medication Management streamlines workflow but does not oversimplify it. Sophisticated features provide support for the way clinicians need to work, including:
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International support: Customization of user interfaces to present data in any Unicode-supported language, and automatic translation and printing of prescription container labels in virtually any language.
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Flexible prescribing: Supports a hybrid of electronic and paper prescribing with scanned and bar-coded paper prescriptions for tracking and accuracy, to foster phased implementation and clinician adoption.
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Intuitive drug screening: Screens drugs automatically based on patient’s profile, giving doctors lists of pre-checked safe medications to select from and minimizing pop-up alerts.
- Electronic Medical Record
The system revolves around an electronic medical record (EMR), providing a comprehensive view into a patient’s experience. Built as an innate part of the overall system, the system draws from functions across the organization to consolidate data that tell the complete story of a patient’s history, condition, and progress. Because the system EMR is a core part of the total hospital information system:
- Information is captured as it is generated, giving continuous insight into a patient’s health record.
- Treatment is expedited by allowing clinicians to focus quickly on immediate issues.
- Patient throughput can be accelerated by allowing current patient encounters, documentation and orders to be automated and simultaneously viewed across the enterprise.
Sophisticated features support effective decision-making and accelerated workflow
- International support allowing flexibility in language, date and time formats for multicultural medical teams.
- Flexible reporting for doctors, promoting adoption by allowing a hybrid between structured and free-form electronic reports.
- Standardized terminology and definitions to enable better communications, documentation, and tracking of trends.
- Bar-coded imaging accommodates paper prescriptions and reports with all the benefits of electronic processing and tracking.
2.2.5 Data Flow Diagram for the System:
The data flow of the hospital can be presented through the following chart:
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Programming
Python, Visual Basic and Java programming language will be used to write the system.
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Testing
Testing of the whole system will be performed into three stages.
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Unit testing: In this stage, the system will be tested individually in different departments.
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System testing: In this stage the total system of different departments will be run together to check if there is any bug in the system that can hamper the process.
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Acceptance testing: If no problem is identified during the system testing, then we will go for the final test of the whole system. If the system passes this test, then it will be proved that the system has successfully been created.
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Conversion
We will go for a Pilot Study strategy to gather information prior to a full installation of the system, in order to improve the latter’s quality and efficiency. A pilot study can reveal deficiencies in the design of a proposed system and these can then be addressed before time and resources are expended on large-scale studies.
Although it is unlikely that a pilot study alone can provide adequate data on variability for a analysis, the study may, however, provide vital information on the severity of proposed procedures or treatments.
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Maintenance
At this stage, a post-implementation audit will be conducted to review the user requirements and the system functionality, to evaluate the success of the system for hospital management.
The scope of the post-implementation audit includes an assessment of risk elements in the following areas:
- System Functionality and User Needs
- Application Security
- Functional Fit Analysis and Re-engineering Strategy
- Communications and Training Issues
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End User Training
The key to a successful implementation of any enterprise application software is proper end-user training. Our end-user training program, which will include custom courseware, hands-on training and a variety of instructional tools that help users become system experts, so that the system delivers the expected return.
Our training delivery options include:
- Custom courseware
- Job aids
- Quick reference guides
- Instructor guides
- Hands-on labs and exercises
- Instructor- Led Training
- Distance Learning
- Help desk to support the system users – having a team available to aid technical difficulties and answer question
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System Security and Control
Since the Internet is essential environment for our system, the discussion of security issue is inevitable. However, this is general issue to be always discussed when local area network is connected to the Internet.
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Threats Detection:
LAN security risks come in different forms. The most common ones could be:
- Viruses
- Probes
- Trojan Horses
- The "Netlog" Worm
- Identity Theft
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Preventive Actions:
The key technologies which will be used in our system to get protected from the threats are:
- Encryption
- Firewall
- Digital signature
- Authentication
- Antivirus
Conclusion
It can thus be seen that deploying information system can help the medical profession in improving its quality of service and thus automatically increasing the preparedness and defensiveness. Of course, it is of vital importance that the software must have the right type of modularity and openness so that it is manageable, maintainable and upgradable. The hardware should also be reliable, available and have the necessary performance capacity.
Certainly, computers with their intrinsic power can play a major role in a hospital. Computers can act as a communication link between departments and allows the common database to be shared by them. Well designed, integrated information system can be a great tool in the hands of the hospital management in improving services, controlling cost, and ensuring optimal utilization of facilities.
Reference
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Hospital Information System in Medicare: An Experience at TATA MAIN HOSPITAL, Jamshedpur by Mohanty, Rajesh; Rana, Sarosh D.; Kolay, Saroj K.
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Integrated Hospital Information Systems: Hospital Based Systems by Smith, A. Laurence, Published by Lulu.com, 2007, ISBN 0979723647, 9780979723643.
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