Hospital Information System ( HIS)

Dr Kithsiri Edirisinghe MBBS, MSc, MD ( Medical Administration)

Objective:

• The course orients the trainees on the ways of managing hospital information for the effective functioning of the hospital. It gives emphasis on the computerization of hospital services.

Contents

1. Introduction to Hospital Information Management: Concept of information management, use of information in hospital administration; application of information system in hospitals.

2. Confidentiality, Security and privacy of hospital information system3. Introduction to Hospital Software 4. Introduction to the Hospital patient care process analysis5. Introduction to IT in medical equipments 6. Introduction to IT Projects

Evaluation method

• Modular exam Structured Essay and MCQ• Assignment – Project report

Contents

1. Introduction to Hospital Information Management: Concept of information management, use of information in hospital administration; application of information system in hospitals.

2. Confidentiality, Security and privacy of hospital information system

3. Introduction to Hospital Software & Projects 4. Management of computerization project in the hospital:

Areas of computerization in the hospital: patient care, medical records, and business administration

5. Modular evaluation : Conceptualize a project on computerization of a hospital service unit

Topic 01

Introduction management Information systems (MIS) Concept of information management and the definitions

and the process involved. Introduction to the hospital information system (HIS )

Basic concepts and categories in information management in hospitals, information flow and the process chart in

healthcare services setting Description and the role of Medical record department and

the responsibilities of the Medical Administrator in HIS.Concept of Electronic Medical Records, current challenges

and advantages.

Data , Information , Intelligence

• Data• Information • Intelligence

Today Tomorrow

Location Hospital Decentralized, at home

Time Symptomatic, curative Preventive, lifetime

Focus On the process and provider On the patient

Scope Cure Patients Care for Citizens

Methods Invasive Less invasive

Healthcare is changing…

Order Process Manual Automated

Experience Individual Best Practices

The Process Fragmented, isolated disease mgt.

Clinical Decisions Personal preferences Guide lines / evidence based

The processes are changing …

Information Fragmented, isolated Consolidated / complete

Today Tomorrow

Data completeness

Fragmented Consolidated

Data integrity Manual/error prone Systematic mgt. and control

Data access Limited, Difficult Any time, any place

Technology Isolated systems Integrated systems

IT is changing …

Data availability

Slow Real time

Today Tomorrow

• Costs must decrease

• Quality must increase– E.g. Medication

errors: in the US 80.000 people died in 2004. (=8th cause of death)

The health care is under pressure ...

The Hospital

Medical Knowledge

High QualityCost Effective

needsActivitiesInformation

Assessmentneeds

produces

Healthcare as a Process

Process

Output

Input

Society

subjectiveobjective

Medical

Community

Assesment

operational

Care Action

Therapeutic ActionDiagnostic Action

Planning

Healthcare as a Process: pain points Isolated information

Fragmented information

Not accessable information

Too much information

Bad information presentation

Only clinical data is kept (no knowledge)

Some information is not computer usable (free text, image features, (genome in the future))

No feed back to medical community and society

Complex desicions

Lack of training

Changing knowledge

Medical errors

Inefficient workflow

Understaffing

No operational information

No infrastructure information

No common language

Input - Output

Information

Process

Clinical Desicions Workflow

Action

Medical

Community

operational Society objective subjective Assesment Planning

Input - Output

Information

Process

Clinical Desicions Workflow

Cure for the pain points – wave 1 PAS: Patient Adminstration

System

HIS: Hospital Information System

Result Distribution

ActionMedical

Community

operational Society objective subjective Assesment PlanningCollect

Cure for the pain points – wave 2 PACS: Picture Archiving And Communication Sytem

PAS: Patient Adminstration System

HIS: Hospital Information System

CIS: Clinical Information System

Care

Order Entry

Medication prescription

Result Distribution

Input - Output

InformationProcess

Clinical Desicions Workflow

ActionMedical

Community

operational Society objective subjective Assesment PlanningCollect

Desicion support

Optimization

Cure for the pain points – wave 3 Information filtering

Decision support

Semantic driven UI

Clinical Pathways

Evidence based medicine

Clinical Trials (in- and exclusion criteria, data mining)

Terminology

feature extraction from unstructured or massive information (images, free text)

Advanced connectivity

Content

Workflow optimization

Intelligent patient portals

Remote data capture

Community HealthCare

Input - Output

Information

Process

Clinical Desicions Workflow

ActionMedical

Community

operational Society objective subjective Assesment PlanningKnowledge

Desicion support

Optimization

Common to all this is …

Adaptable Clinical Workflow Framework

Society subjective objectiveMedical

Community

operational

Assesment

Care Action

Therapeutic Action

Diagnostic ActionPlanning

1. Introduction

• Hospital consists of multiple variety of function performed by different categories of people

• With limited resources these personnel are expected to produce an output with an acceptable quality.

• Strict regulatory process and more documentation in the hospital process have hampered these personnel performing assigned actual technical work, resulting unproductive low quality service outputs. EX. Nursing care

Justification

• Due to Scarce Human Resources, existing Human resource should utilize in a most productive and cost effective manner

• Hospital Information system will make people more efficient by collecting & distributing information faster, making use of the same human resource.

• Efficient MIS essential for the hospitals in today’s context.

Primary objectives of HIS

1. To make a cost effective hospital2. To provide quality services to their patients3. To enhance the decision making process4. To support user confidence 5. To boost hospital professionals commitment

Requirement of a HIS in a hospital

• Daily management of operations• Competitive planning strategy• Controlling dissemination of information• Processing volumes of data• Providing information for medical & financial auditing• Inventory management• Interaction between department heads for planning,

coordination, & control activities • Provision of information for national level policy,

decision making.

2. Benefits of HIS• Health administration: Per patient information administrative work

and making him more competitive in his work, prepared for auditing & legal demands.

• Medical research & development for response & preparedness.• Improvement in Quality & efficiency in patient management:

Pictorial & image data presentation increases for medical imaging services

• Process coordination & improvement: Networking of units• Increase efficiency of HR: It is estimated 40% of HR time is spent on

in formation gathering, processing & disseminating work.• To identify & improve areas of inefficient areas in terms of service

delivery & cost.

3. Current Gaps in HIS in hospitals

• Management & medical systems: Underutilization of available data in day-to-day management, unavailability of soft ware & hard ware.

• Hospital & clinical systems: Incomplete data sheets, low man power

• Hospital staff & data base developers: little or no knowledge in respective personnel regarding IT & hospital activities. Poor communication & lack of interest of the mentioned categories

4. Methodology

• There are several approaches to constructing HIS.• Supporting activities of functions

– CEOs information system• Point of scale method (POS)

– Build around the Patient• Top down method

– Build around Cooperate plan, targets, to functional goals

• Local Area Net work method (LAN)• Analogous system

5. Functional modules in a HIS

• There are two major categories in HIS1. Clinical 2. Administrative.

A. Clinical • Ward management• OPD management• Operation Theater• CSSD• Transfusion services• Ambulance services• Medical records• Special unit management: ICU, ETU,• Labor room and PBU• Diagnostic services: • Laboratory, Radiology, ECG, & EEG

B. Administration

• Front office• Registration• Appointments• OPD Administration• OPD billing & IPD billing• Stores• Pharmacy• Marketing• Financial accounting• HR

7. Implementation strategy of HIS

• Development of long-term plan for five-year period with short tem, annual plans.

• Identification of current operational problems & need for soft ware solutions, making phase wise deployment of those solutions.

• Site visit & determining estimating how the soft & hard wear enhance work process.

• Cost effective Method of the development of the soft ware; Purchase, in-house development or customization of developed soft ware.

7. Implementation strategy of HIS

• Placement of computers, printers in points of revenue generation & service centers and the cost.

• Determine the net work configuration: local & other connections

• Develop & plan for a training programme • Introduce audit & review systems, operation

delivery systems • Development of implementation strategy

8. Key activities of HIS implementation

• Determination of priorities

• Defining architecture• Outsourcing needed

activities• Evaluate & select solution • Evaluate criterion of

applications• Customize & implement

applications

• Building computer premises

• Acquire the resources• Install the equipment • Establish task force• Site visit• Empower uses

9. New Technologies

• Telemedicine • Medical records• Smart Card• Digital library• Multimedia

10. Resources for installing HIS

• Operating system• Data Base management• Antivirus soft ware• Server• Data base backup drive• Ups• Terminals• Hub• Manpower• EDP room• Cables ,Panels & outlets

Developing a hospital information system in a hospital

The project

• Planning • Implementation • Monitoring • Evaluation and feed back

The project plan

• Identification of the “needs gap”• Plan a system as per the requirement to

improve the quality , reduce cost and other resource constrains

Identification of the needs gap

• Study the process flow • Identify the bottle necks and red tapes and

time , money and resource wasting area . Also the high risk areas needs quality improvement

Process flow

• Service industry • Services process • Core process – Direct Patient care services • Support process – Administrative /support

services• Consider core service initially and then move

on to support process ( depending on the cost , time , quality and other resource importance

Patient care process

• Identify services units – OPD, IPD, CCU, ETU etc.

• Select Key result areas – functions • Functions – sub unit level

– OPD -reception Registration , Payment

• Activities • Tasks

OPD

• Reception • Registration • Payments • Consultation • Investigation • Treatment • Dispensing

The process

• Study the process as per the core patient care services

• Identify the Key result areas• Identify the functions • Study the information flow • Validate the current methods• Identify gaps • Propose the system support • Also look at integration of each units

Activity 01

• Develop a process and the information need for a IPD services

Selection of a system

• Select / modify or develop system as per the need

• Step by step implementation - modular fashion • Unit by unit as per the process flow – OPD to IPD

and then to CCU• Closely follow the “ Human Response”• Monitoring and feed back essential • Clinical and administrative modules

Clinical modules • Ward management• OPD management• Operation Theater• Ambulance services• Medical records• Special unit management: ICU, ETU, Labor room and

PBU• Transfusion services, Ambulance services• Diagnostic services: Laboratory, Radiology, ECG, & EEG

Administration modules

• Front office• Registration• Appointments• OPD Administration• OPD billing & IPD billing• Stores• Pharmacy• Marketing• Financial accounting• Human resources

• Catering• House keeping• Purchasing• Customer care• Security

HIS modules

Assignment

• As a ward In- charge , you are requested formulate a Project proposal to be given to the IT specialist in order to construct a hospital software to your Medical ward .

• 500 words

Telemedicine

Tele Medicine

• Telemedicine is the use of telecommunication and information technologies in order to provide clinical health care at a distance. It helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities. It is also used to save lives in critical care and emergency situations.

• Diagnosis , treatment and monitoring and rehabilatation

V 07

Thanks

Thank You!