- EXPERIENCE AT A TERTIARY LEVEL HOSPITAL

Transcription

1 ADOPTION OF INFORMATION TECHNOLOGY IN HEALTHCARE DELIVERY - EXPERIENCE AT A TERTIARY LEVEL HOSPITAL DR SOMU.G ASSOCIATE PROFESSOR DEPARTMENT OF HOSPITAL ADMINISTRATION KMC MANIPAL

2 INTRODUCTION Earliest use of IT in health care o Administrative purpose o Computerized budgeting o Financial planning o Medical offices- specific needs only

3 INTRODUCTION What was lacking? o Integration of computer systems via EMR o Standard computerized sign-out system o Patient problems list o Treatment undertaken/given o Prescription of Medication

4 INTRODUCTION In recent years, focus is on. o Cost of providing high quality services o Patient satisfaction in hospitals Use of information system- best solution!! o Decreasing cost o Increase patient satisfaction o Improve hospital-processes o Provide high quality patient care

5 Definition: Hospital Information System (HIS) is defined as a computer system designed to ease the management of all the hospital s medical and administrative information and to improve the quality of healthcare -Degoulet and Fieschi (1997) HIS is a hospital wide system or network designed to support the flow of information between departments -Sneider (1987)

6 EVOLUTION OF IT THIRD GENERATION (1970 S 1980 s) Influence by data based technology (DBT) Focus on Patient care planning Dept. functioning FIRST GENERATION (1960 s) Administrative tasks Registration Billing FOURTH GENERATION (1980 s..) Focus on integrated HIS facility SECOND GENERATION (mid 1970 S late 1970 s) Involved Financial systems Information transfer from end user to financial system

7 SOFTWARE IN HEALTHCARE Computerization in hospitals o Prevalent since last 5 decades o Evolving changes in hardware & software o Software programming used previously o COBOL; Fox pro o File Data Base (FDB) o Software programming platform at present o JAVA; JSP;.NET; Database; MSSQL; MYSQL etc o Relational Data Base Management System (RDBMS)

8 INTRODUCTION TO HL-7 Health Level Seven International (HL7) o Founded in 1987 o Accredited standards developing organization o Provides comprehensive framework o Exchange; Integration; Sharing; Retrieval of EHI o Electronic health information (EHI) o Clinical practice; Management; Delivery & evaluation of health services

9 HEALTH LEVEL-7 (HL7) "Level Seven" refers to o Seventh level of ISO seven-layer communications model for Open Systems Interconnection (OSI) o The application level interfaces o Directly to the application processes o Performs common application services

10 OPEN VS CLOSED

11 BENEFITS OF IT IN HEALTHCARE Information technology in Healthcare... o Complete management of medical information o Safe exchange of information between o Healthcare consumers o Healthcare providers

12 BENEFITS OF IT IN HEALTHCARE For the Hospital o Improved quality of healthcare o Prevention of medical errors o Reduction in the healthcare costs o Increase in administrative efficiencies o Emphasis on paperless system o Patient documents and records secure o Increased access to affordable healthcare

13 BENEFITS OF IT IN HEALTHCARE General Public Health. o Early detection of infectious disease outbreaks o Improved tracking of severe diseases o Evaluation of healthcare services

14 HIS IMPLEMENTION- A STUDY AIM: To study the HIS implementation process and extent of IT usage in a tertiary level hospital OBJECTIVES: To study the implementation process Assess extent of IT utilization Suggestions based on the study

15 HIS IMPLEMENTION- A STUDY MATERIALS & METHODS: The study was conducted in a large tertiary care teaching hospital. The study design is retrospective o Review of Literature (ROL) o Perusal of records and registers o Informal interviews with the IT staff of hospital

16 IMPLEMENTATION PROCESS Initiating the process.. Inviting company for staging demo Inputs from o Doctors/paramedical staff o User departments-section in charges o Staff of Hospital IT department Correspondences with the company

17 IMPLEMENTATION PROCESS Initiating the process.. First meeting on HIS implementation o Agenda of the meeting o Preparation of action plan for HIS implementation o Review of existing software/hardware support o Requirements based on review

18 IMPLEMENTATION PROCESS STEP-2 Procurement of software/hardware support Installation & configuration of Server RM COBOL runtime ILink software Client machine configurations

19 IMPLEMENTATION PROCESS STEP-3 Study of existing modules Gap analysis Providing software support

20 Sl. No Module Name Sl. No Module Name 1. Access Module 8. Pharmacy Module- Retail 2. OPD Module- Registration 9. Medical Records 3. OPD Module- Billing 10. General Stores 4. Inpatient Module- Admission 11. Purchase Module 5. Inpatient Module- Registration 12. Linen Module 6. Finance Module 13. Diet & Food Services 7. Pharmacy Module- Bulk

21 IMPLEMENTATION PROCESS STEP-4 Installation in phases First Phase o o o Access (Admin) module OP registration& billing modules IP registration & billing modules Second Phase o Pharmacy module (Bulk/retail) o MRD o General Stores modules

22 IMPLEMENTATION PROCESS STEP-4 Installation in phases Third Phase o Purchase module o Finance module o Linen module o Dietary & Food Services module

23 IMPLEMENTATION PROCESS STEP-5 Training session for the end user o Conducted by professional from company o Instructors deputed full time for training o Training conducted in afternoons o Duration of training o 5-6 hours per day o Over one week

24 TRAINING SCHEDULE DAYS DEPARTMENTS DAY-1 DAY-2 DAY-3 OP-Registration OP- Billing IP- Admission IP- Billing Wards DAY-4 Pharmacy- Bulk Pharmacy- Retail DAY-5 General Stores- Bulk General Stores- retail DAY-6 Medical records Section

25 COUNT DOWN. Policy decisions before going LIVE o Three staff per department deputed for training o Go LIVE only after 8-day error-free running o Old system to run in parallel

26 COUNT DOWN. Policy decisions before going LIVE o Show stoppers incorporated in new system o Simulation testing over 7-10 days for compliance o New software installation planned thereafter..

27 IMPLEMENTATION PROCESS STEP-6 Going Live Process (Pre-preparation) o All department heads taken into confidence o Ensured that all the show stoppers cleared o Department heads consented for ready to go live o Master Checklists pre and post going live prepared

28 IMPLEMENTATION PROCESS STEP-6 Going Live Process (Pre-preparation) o Discharges kept at minimum o Manual billing option made available o Provision for preparing IP billing kept open o Checklists prepared for each module

29 IMPLEMENTATION PROCESS STEP-7 Going Live (Post-live) o Advance payment serials did not continue from the last serial

30 INTERFACING Special Purpose applications o Picture Archival & Communication System (PACS) o Laboratory Information System (LIS) o Radiology Information System (RIS) o Clinical Decision Support System (DSS)

31 CHALLENGES IN IMPLEMENTATION Resistance to change o Existing system to upgraded system o Both old & new system running in parallel Stock report checking of 70 wards o Done Pre-live and post-live o Limited hospital IT staff

32 CHALLENGES IN IMPLEMENTATION Limited hospital IT staff o On the day of going LIVE Technical hitch o Delay in going live (10:30am) o Managing patient crowd early morning

33 LESSONS LEARNT Window based HIS package preferred o Interfacing is easy o Easy access for query function Before planning for HIS implementation o In-depth study of existing system a MUST o Identify drawbacks in existing system o Overcome in the proposed new system

34 LESSONS LEARNT Undertake Gap analysis o Consider future requirements also Proper impact analysis (10-15 years) o Consider changes/requirements of end users o Ensure defects not reflected in other processes Active involvement of process owners o Key to fruitful implementation of any new project

35 CONCLUSION Comprehensive HIS.possible??? o Huge investment for acquiring technology o Depreciation & obsolescence of IT products o Other contributing factors: o o Hospital functions in dynamic environment Customer focused & market focused o Need to keep pace with advances in science & technology.

36 CONCLUSION Implementing the HIS modules. o administrative applications o clinical applications o special purpose applications etc need based & phased manner Following to be considered o o Adhere to a standard protocol User friendly

37 TAKE HOME MESSAGE To reap the benefits of IT implementation Productivity/Cost control/effectiveness etc....adapting an open system architecture sensitized to the ever changing IT Very Essential

38 REFERENCES 1. Lillian Burke, Barbara Weill, Information Technology for Healthcare professionals, Second Edition, 2005;Pearses Education Inc, New Jersy. 2. Ozge Sagiroglu, Meltem Ozturan, Implementation Difficulties of Hospital Information Systems, Information technology Journal 5 (5): , Degoulet.P, M.Fieschi, Introduction to Clinical informatics. Springer, New York 4. Sneider.R.M, Management Guide to Healthcare Information System. Aspen, Rockvillen Maryland 5. Accessed on Accessed on closed_systems.html Accessed on Dr. Naval Kishore, Computers in Medicine, third edition 2000,Vikas Publishing House

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