INSTITUTE OF HEALTH MANAGEMENT RESEARCH
BANGALORE
A REPORT ON
“HOSPITAL INFORMATION SYSTEM “ AT FORTIS HOSPITAL, NOIDA
SUBMITTED BY- ADITYA KUMAR VARSHNEYA OF POST GRADUATE DIPLOMA IN HOSPITAL AND HEALTH MANAGEMENT PGDHM 2011-13 BATCH
AS A PARTIAL FULFILLMENT OF THE SUMMER TRAINING REQUIREMENT OF PGDHM PROGRAM
(16TH APRIL- 16TH JUNE, 2012)
IN SUPERVISION OF
Col.H.S.BHAGAT (GENERAL MANAGER, FORTIS, NOIDA)
1
ACKNOWLEDGEMENT The successful completion of any given task requires a lot of hard work and sincere efforts. Hard work and efforts are only the building blocks of an assignment, but the plinth has to be inspiration, suggestion, support and guidance. Experience in a hospital environment is an important part of my course and this I have achieved from one of the esteemed health care organization, Fortis Hospital, Noida. These two months of training has added a valuable and knowledgeable exposure in the development of my career and achievement of my objectives, for which I am highly grateful to the organization Any attempt at any level cannot be a success without the support and direction of learned people. A heartfelt gratitude to Dr. Sukhmeet Sandhu (Zonal director,) and Dr. Akash Sud (Medical Superintendent), at Fortis Hospital, Noida, for giving us the golden opportunity to work with the India’s leading health care provider. My heartfelt gratitude to Ms. Alfons Madoc ( Head HR) and Ms. Smita Roy Angrish (HR Manager) for showing keen interest in our training, helping us to plan our agenda and guide us despite their busy schedule. I would like to express my immense gratitude to Col.H.S.Bhagat (General manger, operations) for providing his support and guidance not only for the project in the hospital, but for broadening my horizon and making me learn various other aspects of hospital functioning, which will definitely help me a lot in my career. And yes, and for directing my goals and objectives towards the attitude that derives to achieve and other aspects that one needs to be acquainted with. My learning here in two months is all because of his help. I would also like to extend my gratefulness to Mr.Kaptan Sharma (HOD, IT dep’t.), Mr. Nitin Khanna (Head, Medical Administration), Mrs. Anju Panwar (HOD, House-keeping), Ms. Neeru Raina (HOD, PCS) for helping and guiding me throughout the project and helping me learn various other aspects too. I am glad to acknowledge Dr. K.S. Srinivasa Rao (Director- IHMR-Bangalore), Dr. Fehmida Visnegarwala and Maj.Gen.N.K.Manchanda (Mentor) for incorporating right attitude in me towards learning and for supporting me whenever required. I genuinely thank my parents, family and friends for their blessings and support. Last but not the least I am thankful to God, for getting an opportunity to learn from this organization. 2
TABLE OF CONTENTS
CONTENTS S NO.
TOPIC
PAGE NO.
1
Abbreviations
5
2
Introduction
6
3
SECTION orientation study
AHospital & departmental
7
4
1.0 History
8
5
1.1 The Fortis Logo
9
6
1.2 The Mission
9
7
1.3 The Vision
10
8
1.4 Values
10
9
1.5 Committees in the hospital
11
10
1.6 Organ gram
12
11
1.7 Infrastructure 1.7.1 Departments of the Hospital 2.0 Departmental Profile 2.1 OPD 2.2 IPD 2.3 Human Resource 2.4 Marketing Department 2.5 Dietary and Nutrition 2.6 Housekeeping
13 14-15
12
3
16-21
13
2.7 CSSD 2.8 TPA 2.9 Store and Purchase 2.10 Engineering and Maintenance 2.11 Finance 2.12 MRD 2.13 Security 2.14 IT Department Department study
22-31
14
Executive summary
33
15
Introduction
34
16
HIS- objective
35
17
Functional Coverage
36-37
18
HIS-Fortis
39-42
19
Cloud computing
43-45
20
46-49
24
House Keeping Module With recommendations Nursing and Diet Module With recommendations IT and Store Module With recommendations OPD Module With recommendations Other recommendations
25
Fortis HIS-Future
65
26
Data Flow chart
66-69
27
Conclusion
70
28
Reference
71
29
Annexure
72
21 22 23
4
50-54 55-58 59-63 64
ACRONYMS/ ABBREVIATIONS HIS-Hospital Information system CSSD- Central Sterile Services Department CT- Computerized Topography CTVS- Cardio Thoracic Vascular Surgery ECG- Electrocardiogram ER- Emergency Room FMS- Facility Management and safety F&B- Food & Beverages HAZMAT- Hazardous Material HR- Human Resource ICU- Intensive Care Unit IPD- In-patient Department IT- Information Technology MICU- Medical Intensive Care Unit OPD- Out-patient Department OT- Operation Theatre LIS- Laboratory Information System RIS- Radiological Information system PACS-Picture Archiving and Communication System DICOM-Digital Imaging and communication in medicines RFID- Radio Frequency Identification CPOE- Computerized physician order entry EMR- Electronic Medical Record PHC-Preventive Health Checkup
5
Introduction Summer Training is an integral part of the Post Graduation Diploma in Hospital Management (PGDHM). The main purpose of this summer training is to get an orientation towards the layout, operations and workflow of the hospital, in order to understand the processes and systems in the hospital. After completing the first academic year of PGDHM, the students are supposed to undergo a two months training in a hospital, as a part of the curriculum. Indeed I have got the golden opportunity to work in Asia’s leading Healthcare provider, Fortis Group of Hospitals. I joined Fortis Hospital, Noida, from 16th April, 2011 for summer internship. The duration for the summer training is of 2 months i.e.16th April to 16th June. AIM: To have an overall orientation / induction of the hospital setting. Objectives: 1. To get an overview and develop understanding of the hospital’s functioning. 2. To gather knowledge about the process flows of major clinical and non clinical departments in a hospital. 3. To help the management study and address some issues/problems associated with some specific operational area/department.
6
Section-A
“Hospital Orientation & Departmental Study”
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1.0 History: Fortis Healthcare Limited was established in 1996 by its founder, Late Dr. Parvinder Singh. His vision of medical care was, “To create a world class integrated Health Care delivery system in India, entailing the finest medical skills combined with compassionate patient care.” Fortis took its first step towards becoming a world-class provider of integrated healthcare delivery in India by setting up its first hospital at Mohali, Punjab. Fortis Hospital, Noida was inaugurated on 7th November 2004, which is a centre of excellence in Orthopaedics and Neuroscience with additional focus on Cardiac Sciences, Minimally Access Surgery and Oncology. The hospital has a built over area of 5.53 acres and the allocation of space far above the current Indian norm of 800-900 sq.ft/bed. The total build up areas is 2.20,000 sq. ft with patient centric design by Kaplan Mc Laughlin Diaz (KMD) USA (award winning designers for FHI & MSH). This allows for flexibility to adapt and accommodate future trends of patient care. The Fortis Hospital at Noida, near Delhi, is a centre of excellence in Orthopaedics and Neuroscience with additional focus on Cardiac Sciences, Minimally Access Surgery and Oncology. It is a hub where some of the best medical professionals provide quality medical treatment catering to the special needs of patients and their families. The hospital has been designed and developed to deliver patient care with maximum ease warmth and effectiveness. Fortis Hospital Noida has also achieved many first to its name: •
1st NABH Accredited Hospital in U.P.
•
1st NABH Accredited Blood Bank in U.P.
•
1st NABL Accredited Lab services in U.P.
8
1.1 The Fortis Logo:
LOGO “A HEALING PASSION” The Fortis Healthcare Limited Logo defines the commitment to patient care. The logo reflects their endeavour to achieve excellence in healthcare delivery system by bringing together the best of technology, medical expertise, and patient care. The logo also implies the human values that govern every facet of our organization. The 2 nurturing hands along with a red dot on the top depicts- “nurturing hands caring for human life” GREEN is a color of healing and depicts WELLBEING and RED is symbolic of steadfast focus, dynamic zeal and enthusiasm 1.2 Mission: •
To become an Integrated Healthcare delivering organization guided by quality, excellence, technology and compassionate patient care.
•
To establish Fortis Hospital Noida as a major corporate hospital in healthcare
Vision
Globally respected healthcare organization known for Clinical Excellence & Distinctive Patient Care
delivery system in the region.
Achieved by
“Foundation”
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Talented People
Ethical values
Efficient Systems
Trust
Contribution to society & stakeholders
1.3 Vision: Globally Respected Health care organization recognized for Clinical Excellence
and
Distinctive Patient Care. 1.4 Values: They serve as a guideline for the routine conduct of each Fortisian. The core values of Fortis Healthcare are:
Patient
• Commit to 'best outcomes and experience' for our patients.
Centricity
• Treat patients and their caregivers with compassion, care and understanding. • Our patients' needs will come first
Integrity
• Be principled, open and honest. • Model and live our 'Values'. • Demonstrate moral courage to speak up and do the right things.
Teamwork
• Proactively support each other and operate as one team. • Respect and value people at all levels with different opinions, experiences and backgrounds. • Put organization needs' before department / self-interest.
Ownership
• Be responsible and take pride in our actions. • Take initiative and go beyond the call of duty. • Deliver commitment and agreement made.
Innovation
• Continuously improve and innovate to exceed expectations. • Adopt a 'can-do' attitude. • Challenge ourselves to do things differently.
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1.5 Committees in the Hospital: 1.
Quality Steering Committee
2.
Hospital Infection Control Committee
3.
Safety Committee
4.
Sentinel Events Committee
5.
Blood Transfusion Committee
6.
Code Blue Committee
7.
Pharmacy and Therapeutic Committee
8.
Medical Audit Committee
9.
Research and Ethics Committee
10.
OT Committee
11.
MRD Committee
12.
Morbidity and Mortality Committee
13.
CME Committee
14.
Purchase Committee
15.
Condemnation Committee
16.
Credentialing and Privileging Committee
17.
Sexual Harassment Committee
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1.6 Organ gram
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1.7 Infrastructure: The hospital offers world class infrastructure. It is designed as a green building to allow natural light into almost all parts of the building especially patient care areas. The architecture allows conservation of energy. The building is earthquake resistant. CFL lights have been used, thereby reducing power consumption. The space provided in the various departments is sufficient to move freely. CCTVs installed all over the building act as digital watchmen and help in security services. An efficient Hospital Information System is used to store all medical records. The Hospital is equipped with: •
250 bedded hospital with 191 beds currently in use.
•
8 ICUs with 63 beds: Medical, Surgical, Liver Transplant, Kidney Transplant, Cardiac, Neuroscience, CTVS and Neonatal ICU.
•
7 OTs
•
2 Cath Labs (Neuro Cath Lab and Cardiac Cath Lab)
•
4 bed -Triage & 6 observation beds -ER
•
11 bedded Dialysis centre equipped with modern dialysis machines like SLED (sustained low efficiency dialysis machine) and providing 24 hrs. Coverage.
•
Diagnostic facility comprising of 1.5 Tesla MRI scanner, 64 slice CT scan, 4 X-Ray
units, 3 Ultrasound units, 1 Mammography machine and 1 Bone dexa scan machine. •
All laboratory services of world class standard like histopathology, microbiology, biochemistry and hematology are present.
•
Ambulances which transport patients to the hospital emergency.
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1.7.1 DepartmentsDEPARTMENTS IN THE HOSPITALThe OPD (Outpatient Department) are Pulmonology Rheumatology Obstetrics & Gynecology Pediatrics Physiotherapy Orthopedics Psychiatry Ophthalmology Dental Dermatology Diabetes and endocrinology Internal medicine Sports medicine ENT Emergency medicine Radiology 14
Speech therapy Music therapy Gastroenterology Neurology Neonatology Infertility Dialysis
The surgical procedures carried out in the hospital are General surgery Cardiac surgery Laparoscopic GI Bariatric surgery Neurosurgery Thoracic surgery Vascular surgery Plastic and reconstructive surgery Liver transplant Bone-marrow transplant
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Other services in the hospital are-
Blood bank
Laboratory services
CSSD
Pharmacy
Preventive health check-ups
Patient care service
Day care
Clinical nutrition
International Oncology Centre, NoidaInternational Oncology in strategic collaboration with Fortis Hospital, Noida brings to patients a state-of-the-art cancer centre equipped with cutting edge technology and offering comprehensive cancer care under one roof. Currently, Fortis Noida acts as a hub to the spoke at Fortis Vasant Kunj and Escorts, Faridabad. It acts as a referral spoke to the Noida centre. The spokes carry out cancer treatment pertaining to surgeries, chemotherapy, biopsies, tests and scan, except high-end radiation oncology, for which the patients are referred to the main regional hub at Fortis Noida. Also, they have strategic collaboration with Albert Einstein College of Medicine (USA) for advanced physician trainings and for seeking second opinion for complex cases.
Also, Fortis hospital, Noida has a TELEMEDICINE UNIT that carries out CME (continuous medical education) under the PAN-AFRICA e- network project. It has also allowed their network to expand its presence by extending quality healthcare treatment to the remote areas of Northern India as well as overseas. 2.0) DEPARTMENTAL PROFILE2.1 OPD 16
Functions: Reception/Information Appointment Registration-OPD, Diagnosis Billing-OPD, Diagnostics, Emergency Report/Document delivery Customer Feedback REGISTRATION PROCESS OF OPD PATIENT ENTERS INTO THE HOSPITAL
PATIENT APPROACHES THE OPD REGISTRATION DESK
PATIENTS FILLS THE REGISTRATION FORM
INFORMATION IS ENTERED IN TO THE HIS OF THE HOSPITAL
THEN, UHID (UNIQUE HOSPITAL IDENTIFACTION) IS GENERATED
BILLS ARE PROCESSED
2.2 IPD Functions: Reception/Information Appointment Admissions- IPD services(including Daycare) 17
Report/Document delivery Customer Feedback Processing of TPA and corporate patient files
2.3 Human Resource Department: Functions:
Development of HR policies and strategies
Manpower Planning
Recruitment and Selection
Employee Training
Salary Determination
Performance Appraisal
Personnel Data entry and record maintenance
Consultation and Advisory services to management and employees
Grievance Handling
2.4 Marketing Department: Functions:
Branding and Promotion
Online marketing through website
Corporate link-ups
TPAs
Prepare brochures and pamphlets
2.5 Dietary and Nutrition (Food and Beverages) Functions:
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To ensure that Patient management system (PMS) is done according to F & B service
standards
Outpatient Diet counseling
To educate all inpatients during hospitalization and at the time of discharge for therapeutic diet requirement
To ensure proper room service to the attendants.
To check the quality of grocery items as per the approved brand list and standard
specifications
Food services to consultants, doctors, and rest of the staff
Food services extended during guest visit, CME, workshop and other important meeting.
2.6 Housekeeping Functions:
Sanitation and Hygiene
Odour control
Waste disposal
Pests, rodents and animal control
Interior decoration
Infection control
2.7 CSSD The objective of establishing this department is to make reliably sterilized articles available at the required time and place for any agreed purpose in the hospital as economically as possible. Functions:
It receives stores, sterilizes and distributes to all departments including the wards, OPD and
other special units.
It processes and sterilizes syringes, rubber goods (catheters, tubing etc.), surgical
instruments, treatment trays and sets, dressing etc.
It ensures economic and effective utilization of equipment resources of the hospital under
controlled supervision.
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2.8 TPA TPA companies are BPO of insurance companies and are responsible for coordinating all aspects of claims arising due to health insurance policies. These companies are licensed by IRDA.
2.9 Store and Purchase Stores receives all equipments, instruments and items of raw material, consumables, printing and stationary, medicines and other essential goods required by the hospital. Functions:
Procurement of stores through indigenous and foreign resources
Checking of requisition and purchase indents
Negotiating contracts
Issue of purchase order
Follow up of purchase orders for delivery in time
Serving as an information centre on the materials’ knowledge.
2.10 Engineering and Maintenance Functions:
To maintain electric and water supply
Air conditioning and refrigeration
Intramural transportation
2.11 Finance Functions: The functions of the financial departments are interlinked with the functioning of practically all other departments. The primary and essential functions of this department are: To maintain financial records 20
To make payments of bills and expenses on time To collect accounts due To monitor the cash flow/ funds To make payments of wages and salaries To provide information regarding financial condition to managers and decision makers of the hospital
2.12 Medical Records Department Functions: Proper storage and maintenance of medical records Maintenance of integrity and confidentiality of medical records Submission of required data to government Classify the medical files as per ICD-10 Obtaining missing patient files
2.13 Security Security services ensure the total safety and security of the internal as well as external customers. Functions: To secure the infrastructure and hospital property Safety of patients Control of flow of visitors VIP security Parking management
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2.14) IT Department Functions: Maintenance of all the software’s in the hospital. Modifications of the software are as per the requirements of the department.
It covers the following modules: •
IPD Billing
•
OPD Billing
•
Administration
•
House keeping
•
Ward/Nursing
•
Diet
•
Visitor’s pass
•
Stores
•
Purchase
•
Laboratory Information System
•
Radiology Information System
DEPARTMENTS STUDIED IN DETAIL: 1.
EMERGENCY DEPARTMENT-
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The emergency department in a hospital serves to the need of patients who are in need of immediate care i.e. accident cases, trauma cases, suicidal cases, medico legal cases etc. The ER at FHN is 4 bedded along with 6 beds in the Observation room. Also, there is a procedure room to conduct simple surgical procedure. ER has separate entry, far away from the general entry and is quite spacious in order to allow free movement of stretchers/trolleys from the ambulance to the Emergency room. While bringing in the patient from the ambulance, TRIAGE is done beforehand by the staff nurse at the ER reception and so patients are placed according to the triage bedsTHE TRIAGE pattern followed here is
1 red bed for category 1 patients i.e. critically ill
3 yellow beds for category 2 patients who need to be admitted
Remaining category 3 patients are kept in observation room There are 4 ambulances in the ER department, the movement of which depends on the central
emergency call centre at Fortis Escorts, Okhla. The Fortis group of hospital in Delhi and NCR has a centralized ambulance call centre at Fortis Escorts, Okhla (105010) where all the calls for requirement of ambulance are received and depending on the location of the case, the nearby Fortis branch is contacted, a case id is given and then the ambulance is sent the required location. A Crash Cart is available in the emergency which provides a one place storage of all emergency medications required which saves the precious time during treatment.
A Code blue team is designated which consist of 2 teams a)
ICU Team
b)
Emergency Team
The dial code for individual disaster is 55 and as soon as the information is reached to the code blue team, the team reaches the required place and take with them the “jump kit and the defibrillator”.
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ACCESSIBILITY WITH OTHER DEPARTMENTSThe ER is located on the ground floor, making it quite accessible to the other departments. The diagnostic department is right next to the emergency department but the ICU and OT’s are at the second floor and it takes 4-6 minutes to reach there. Moreover, there is a direct inter- communication system between emergency department and other services like blood bank, lab, diagnostic, ICU etc. It is all linked thorough HIS and Intercom service. The Staff in the emergency department is as: a)
Nurses
b)
Doctors
c)
CMO
d)
Paramedical Staff
Generally the patient to nurse ratio is 1:1, but team work approach is always followed whenever the emergency patient arrives. The emergency department have the following equipments’:
Defibrillator
Suction machine
ECG
Cardiac Monitor
Oxymetry
Ventilator
Syringe pump ( for the accuracy of dosage)
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2. BLOOD BANK: The blood bank here at Fortis Hospital, Noida is NABH accredited and is the 1 st NABH accredited blood bank in U.P. The 2 main functions of blood bank isa) Blood donation b) Apheresis For Blood donation, there are 2 beds and for Apheresis there are 3 beds. Apart from these basic requirementsThere are 3 storage rooms— 1. 6 Deep freezers are there. Temperature maintained is -40,-30 &-80 degree Celsius. 2. 3 Blood bag refrigerators are there. Temperature maintained is 2-6 degree Celsius. 3. 2 Agitators are there. Temperature maintained is 20-24 degree Celsius.
Also, there is an infection marker room for following 6 diseases— a) HIV 1 b) HIV 2 c) HEP B d) HEP C e) SYPHILIS f) MALARIA Apart from this, there isa) Quality control room b) Refreshment room c) Apheresis room d) Blood donation room e) Screening room to check for vitals f) Component preparation room The Staffing pattern is25
10 Technicians 1 resident doctor 1 incharge
3. LABORATORY The Laboratory here at Fortis Hospital is outsourced to SRL Lab and all the routine investigations are carried out here only. The staff strength is 30-40 with 3 people working during night. The samples are received from both OPD & IPD patients and a prescription is not always required to get a test done unless the history of the patient has to be traced back. This sample is received in boxes from respective OPD & IPD department and the housekeeping staff carries the same. Also, for emergency investigations, a red seal is marked on the sample as well as on the prescription of the patient so as to give it a priority. Also, all the equipment’s in the lab are automated i.e. they are linked to computers and so all the test results are automatically transferred in the computer and a report is generated. The laboratory has a Laboratory investigation system (LIS). This LIS is connected to the HIS of the hospital in which all the information like- patients name, IPID or UHID, test to be done and the reports is stored. Once the report is generated, it is reviewed by the authorized person and then only it is made available in the LIS or send to the patient. Moreover, there is no telephonic communication of reports results, only during urgent or emergency cases report is spelled out and that too twice to ensure proper communication Quality check and the calibration of the equipment’s is carried out twice in a day for quality assurance.
26
Also, to maintain employee safety i.e. prevent occupational hazard, when an infected sample or any chemical bottle breaks in the laboratory, HAZMAT (Hazardous Material) team is called and immediately the spillage is cleaned up.
List of equipment’s used in the laboratory are Biochemical analyzer Cell counter Urine routine analyzer Immuno assay analyzer Centrifuge Microscan Bactec Tissue processor Microtone Balance Glycosylated hemoglobin analyzer ( D 10 ) Sample mixer Microscopes Pipettes
27
4. CSSD CSSD stands for Central Sterile Supply Department. It is the department that is solely responsible for sterilization of all the instruments used all over the hospital. CSSD has 3 zones: a) Dirty/Receiving Area b) Clean Area c) Sterile Area a) In Dirty Area all used instruments from IPD & OPD are received after they are washed and. This movement takes place manually, while it is received through a dumb waiter from the OT. Here, an ultrasound cleaner is located. This is a fully automatic machine in which the used instruments are dipped in a solution and are sterilized under 40 degrees Celsius for 10-15 minutes. This machine produces vibrations which sterilize the instruments. After the above procedure is over, the sterilized instruments are washed under running water. After this the instruments are dipped in Preserve solution for 10-15 minutes. b) In Clean Area, the sterile instruments are kept packed in a double wrapped green colour cloth c) In Sterile Area there is 1 autoclave machines that is used to sterilize the used instrument. It is a double door machine. Through one door the unsterile instrument is loaded and through the other door the instrument is de-loaded after the procedure is over. •
2 temperature are set in this machine according to the instruments to be sterilized:i.
120 degree Celsius -Under this temperature 20 min is the sterilizing time, 15 min is the dry time and 3 minutes is the pulsing time( Pulsing is an procedure by which the air present in the machine is moved out and steam is moved in)
ii.
134 degree Celsius - Under this temperature, 7 minute is the sterilization time, 3 minute is the pulsing time and 10 minute is the dry time.
After the sterilization process is over, the sterilized instruments are packed and Batch Monitoring Labelling is done through a labelling gun .This labelling consist of: Expiry Date Packaging Date Machine No. 28
Loading No. Sterilization Date
5. IPD (INPATIENT DEPARTMENT) At FHN, there is a separate IPD building which has 5 floors: •
IPD 0-Diagnostics.
•
IPD 1-General wards, single and double room
•
IPD 3- OBG.
•
IPD 4- Cardiac unit.
•
IPD 5- Deluxe, presidential suits.
The hospital has a single central admission and discharge registration no. ( CR No.) for IPD cases, which is used till the patient discharges from the hospital; IPD file is generated by the UHID of the patient, and all the patient information like- Case history, diagnosis along with UHID details are stored. Apart from keeping the files in the HIS, a hard copy of the same is kept in the MRD (Medical Record Department) At each IPD floor, 2 nursing stations are there which helps them monitor the patients effectively. For IPD patients, there is a separate Pharmacy (IP pharmacy) which is connected with all the IPD floors through HIS. The data entry operator enters the drugs to be given to the patients under the supervision of nurse and the list is sent to the IP pharmacy through HIS and accordingly the drugs are sent to the respective IPD floors.
Also, there is a direct intercommunication between IPD and outside services like lab, radiology etc; it is all connected through the HIS. GENERAL WARD: •
There are 7 beds in the general ward and a nursing station is located at the end of the room.
•
Each bed has a nurse call bell system and there is sufficient space of about 4 feet between beds for the movement of carts 29
•
Attached toilet is available at the extreme right corner of the room.
•
Nurse to patient is ratio is 1:6
PRIVATE WARDS • No. of beds 1 or 2 • When compared to general ward, Private wards have a TV, Telephone, Almirah, Drawer, and Sofa cum Couch. • Nurse to patient ration is 1:1
6. ICU (INTENSIVE CARE UNIT) ICU is located at the second floor of the IPD building making it accessible to all the outside services like lab, diagnostics, OT’s etc. There are 8 Different types of ICU’s in the hospital which are as follows: SURGICAL ICU(4 Beds) CTVS ICU( 5 Beds) MEDICAL ICU(16 Beds) NEUROSCIENCES ICU(14 Beds) NEONATAL ICU CCU LIVER TRANSPLANT ICU KIDNEY TRANSPLANT ICU The nursing station is centrally located in the ICU and the nurse to patient ratio in ICU is 1:1. Also, here at FHN, Barrier nursing is practiced in ICU’s so as to minimize the risk of Hospital Acquired Infection (HAI). Equipments used in ICUa) Ventilator b) IABP (Intra Aortic Balloon Pump) 30
c) Suction d) ICD (Inter Costal Drainage System) e) Portable Ultrasound-ray (when needed). f) DVT (Deep Vein Thrombosis) Pump g) Bi-pap to give oxygen to patient
7. OPERATION THEATRESThe operation theatres are located on the 2nd floor of the OPD building having a direct connectivity with ICU (2nd floor of IPD building) so that patient is easily & quickly shifted to and from the ICU. At FHN, there are 8 OT’s31
1) OT 1- Orthopedics & Liver Transplant OT
2) OT 2 & OT 3- Neurosurgery OT 3) OT 4- Major & General ( All cleaned & planned cases are dealt) 4) OT 5 -Cardiac & Transplant
5) OT 6- Planned, cleaned & emergency cases 6) OT 7 -MIS( Infected, Minor, Day-care & Emergency cases) 7) OT 8 -Minor Surgeries
ZONING- Zoning is basically dividing the OT area according to the hygiene maintained in different zones. Here we observed 3 different zonesa) DIRTY ZONE i.e. outside corridor, changing rooms. b) CLEAN ZONE i.e. supply store, scrub area, pre-op room. c) ASEPTIC ZONE i.e. operation theatre, sterile preparation. This zoning is very essential in OT’s as it helps to prevent infection. INFECTION CONTROL IN OT’sOT being such a sensitive area of a hospital, proper infection control mechanisms need to be followed in there. So, for the same, after every surgery they mop & clean the OT with 0.4 % Virex 256 & for Fogging of OT they use 1% Virex For infected cases they use 2% Virex. Also, to maintain proper hand hygiene, there are 3 Scrubbing Stations1) Scrubbing Station 1 is in between OT 6 & 7 2) Scrubbing Station 2 is in between OT 4 & 5 3) Scrubbing Station 3 between OT 1 & 2 Fro hand washing and scrubbing, Micro shield & Betadiene Scrub is used.
For sterilization of instruments, CSSD (central sterile supply department) is there where all the instruments are properly sterilized and send back to the OT. To make this process more effective, a DUMB WAITER is used. 32
DUMB WAITER is a lift which directly connects CSSD with the OT. The used instruments are first cleaned in Instrument Processing Room at OT.
It is then packed in a double wrapped green cloth. This pack is placed on the dumb waiter in dirty area of OT
It is received in the dumb waiter in dirty area of CSSD It is sterilized, packed in the CSSD and a biological indicator is placed in the pack. It is then send from the dumb waiter in sterile area of CSSD It is received in the dumb waiter in sterile area in OT Moreover, for equipments required during emergency in OT, an Autoclave and Ultrasound machine is there, wherein the instruments are sterilized and used. The surgeries are generally conducted from 08:00 AM to 08:00 PM, but in case of emergency, surgery can be conducted anytime. Also, the time duration for a patient to be kept in pre-op room is half an hour and is one hour for post-op room. This is as per the FOS, but it may vary with the severity of the case.
33
SECTION B PROJECT REPORT ON HOSPITAL INFORMATION MANAGEMENT SYSTEM
34
EXECUTIVE SUMMARY: Hospital industry is an important component of the value chain in Indian Healthcare industry rendering services and recognized as healthcare delivery segment of the healthcare industry, which is growing at an annual rate of 14%. The private sector accounts for nearly 80% of the healthcare market, while public expenditure accounts for 20%.Today, a lot of healthcare institutions are investing into multispecialty wings of hospitals. Multispecialty hospitals are very expensive to build and to operate. Administrators and professionals have to be extremely cost conscious. Effective computerised systems and procedures need to be implemented to ensure proper utilisation of limited resources toward quality health care. Patient care management in Fortis healthcare has fully utilised the power of computers in Medicare, whereby network of integrated systems maintaining patient database for the hospital services in the areas of Pathology, Radiology, Medical Research, In-patient Admissions and Billing, Medical Stores & Pharmacy are operational. The implementation of the above modules has evolved user-friendly computerised systems which are loved and cared by all. This project tries to cover giving an insight to the Hospital Information system implemented at the Fortis Hospital Care, Noida which is being fully utilised to provide quality service. The computerised system has enabled the medicos to serve their customers with a smile and to meet the corporate objective set by the founder. I worked in all the departments of the hospital (OPD, IPD, House keeping, and Store) which are under HIS functional coverage detecting the loop holes and redesigning their module for increasing the effectiveness and quality of the hospital operations.
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INTRODUCTION: A hospital information system (HIS), variously also called clinical information system (CIS) is a comprehensive, integrated information system designed to manage the administrative, financial and clinical aspects of a hospital. This encompasses paper-based information processing as well as data processing machines. Computerisation at Fortis Hospital started in a limited way since 2006 when standalone systems were introduced to take care of routine local area needs the emphasis then was mainly on bookkeeping activities. Today, the Medicare areas are computerised. An integrated information system has been implemented in the areas of Pathology, Radiology, Medical Research, Medical Stores & Pharmacy, Inpatient Admissions & Billing. On-line sharing of information has made extension of the existing system to ICU and wards possible, whereby test results can be made available on-line enabling prompt remedial action by doctor. Hospital Information System (HIS) and Electronic Patient Record (EPR) instantly provide patient history details and latest test results to the desktop of the Fortis Healthcare specialist you are consulting, saving valuable time The most recent breakthrough by Fortis healthcare is centralisation of its IT infrastructure by cracking a strategic deal with HCL infotech limited. The Hospitals within the Fortis network will be connected through a centralized IT system installed by HCL which will enable online sharing of patient records and data. Fortis Operating System (FOS), the common operating system for all Fortis Hospitals, will be integrated with the IT system enabling faster decision making and enhanced efficiencies. Hospital Information System (HIS) and Electronic Patient Record (EPR) instantly provide patient history details and latest test results to the desktop of the Fortis Healthcare specialist you are consulting, saving valuable time.
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HIS FORTIS Hospital-MISSION Fortis is a large hospital which devotes considerable emphasis on Patient Care. • The short term objectives of the Hospital Information System in Fortis 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 is to build and maintain a patient database for analysis of data to facilitate decision making process. The following are three primary objectives of its advanced healthcare information system: •
From the organizational viewpoint: To provide the necessary support to the individual units, both within the local environment of the healthcare centre and with respect to the interaction with the other centers operating over the territory ensuring the overall integration and consistency.
•
From the operating viewpoint. To facilitate the users in the execution of their activities, by reducing the clerical work and emphasizing the professional aspects of the various roles. In such a way it is also simplified the introduction of the system in the organizational context and reduced the needs of training.
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• From the technological viewpoint. To permit the construction of an overall distributed, modular and evolutionary framework based on openness criteria and on the adoption of the most adequate architectural, information and technological solutions emerging on the international scenario. This approach permits to optimize the costs, by adopting the hardware and software solutions most adequate to the specific needs, even if developed by different manufacturers.
FUNCTIONAL COVERAGE 37
A brief outline of the functions covered in various modules is given below. •
Admissions/Discharges/Transfers: This module caters to the in-patient admissions and discharges or transfers from various wards/cabins/ICU, registration of casualty/observation patients, birth and death records maintenance, on-line and web based enquiry facility, daily bed availability and monthly Management Information System (MIS) statistical reports.
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Accounts Billing: This module caters to money receipt generation and instant bill calculation for paying cases. Medicine, Pathology, Radiology, MRC charges are available on-line for billing.
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Pathology: This module caters to pathological test request handling and consolidated result entry. Worksheets are printed by various sections of path lab eliminating data entry and increasing data accuracy and timeliness.
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Medical Stores: This module maintains medicine and other appliances, close monitoring of inventory with the help of online stock enquiry, issues of medicines driven by expiry of medicines and maintenance of batch details, analysis of movement, consumption and indent data available with improved vendor control supported by VED/ABC analysis and vendor rating facility.
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Pharmacy: This module caters to accounting of medicines dispensed to patients from counters maintained by automatic indenting from sub store. Control of medicine over dosage and drug to drug interactions are maintained. Statistical analysis available on drug wise/doctor wise.
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Radiology: This module caters to accounting of X-ray films, scheduling of appointments, and reporting of X-ray requests and result entry. Linked with billing module. Statistical analysis of graphical data doctor wise/unit wise/type of X-ray film wise utilization versus wastage etc.
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Medical Research: This module caters to request and result entry for special tests conducted such as T3, T4, TSH, HIV, Hepatitis,FSH etc, linked with Billing module, statistical analysis of data patient wise/test wise etc.
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Communications: In order to extend the reach and range of the existing facilities to the outside world, Fortis has been linked with Internet, Intranet and E-mail facilities.
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Admin module: The module is multidisciplinary and is meant for the administration. It includes the details of the employees and doctors in specific. The revenue details, availability timings, contacts etc. and other relevant record of every doctor are mentioned here. Any person from the top management has the option of looking into the personal details of any of the staff. However, this module is not open to all of the persons of the organizations .Just the marketing and the top management officials can have a look into it.
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AIM: To get in-depth knowledge about the hospital information system of Fortis, Noida
SPECIFIC OBJECTIVES:
1. To understand the complete process flow of Hospital Information system pertaining to
different departments in the hospital AND Accordingly, give suitable recommendations and redesigning their modules to improve the processes and systems of the hospital.
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HOSPITAL INFORMATION SYSTEM AT FORTIS HOSPITAL, NOIDA
There are various titles and acronyms which all declare similar approaches to managing the information flow and storage in hospital routine services, as • • • •
Hospital Information System (HIS), or Healthcare Information System, or Clinical Information System (CIS), or Patient Data Management System (PDMS)
are comprehensive, integrated information systems designed to manage the medical, administrative, financial and legal aspects of a hospital and its service processing. Traditional approaches encompass paper-based information processing as well as resident work position and mobile data acquisition and presentation. A Hospital Information System encompasses every aspect from administration to its financial department. It also includes everything from patient entry and discharge to laboratory tests. Its purpose is to coordinate and/or regulate information throughout the entire hospital. It helps to keep doctors, nurses, and other hospital personnel informed and up-to-date. Hospital information systems are implemented through various IT companies that specialize in health informatics. These systems are implemented in order to do away with paper based systems. These HIS systems help with keeping patient information in a computer so it is easily accessible by all of the personnel of the hospital. Also, by implementing a computer system the hospital is able to recognize trends that the human eye might not be able to see through paper systems. Databases are filled up so data can be organized. Also there are less hospital errors because everybody can understand and read a computer. Before when doctors wrote on paper their hand writing couldn't be understood because it wasn't written properly. These systems also help with the collaboration between different hospitals in order to reduce duplicate testing. Time is also saved by looking at previous data instead of having to re-write it every time the patient goes to a different hospital Advantages Easy Access to Patient Data to generate varied records, including classification based on demographic, gender, age, and so on. It is especially beneficial at ambulatory (out-patient) point, hence enhancing continuity of care. As well as, Internet-based access improves the ability to remotely access such data.
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• It helps as a decision support system for the hospital authorities for developing comprehensive health care policies. • Efficient and accurate administration of finance, diet of patient, engineering, and distribution of medical aid. It helps to view a broad picture of hospital growth • Improved monitoring of drug usage, and study of effectiveness. This leads to the reduction of adverse drug interactions while promoting more appropriate pharmaceutical utilization. • Enhances information integrity, reduces transcription errors, and reduces duplication of information entries. Components of HIS HIS can be composed of one or a few software components with specialty-specific extensions as well as of a large variety of sub-systems in medical specialties, as e.g. Laboratory Information System (LIS), Radiology Information System (RIS) or Picture archiving and communication system (PACS)
Laboratory Information System (LIS) A lab information system ("LIS") is a class of software that receives processes, and stores information generated by medical laboratory processes. These systems often must interface with instruments and other information systems such as hospital information systems (HIS). A LIS is a highly configurable application which is customized to facilitate a wide variety of laboratory workflow models. Deciding on an LIS vendor is a major undertaking for all labs. Disciplines of laboratory science supported by LISs include haematology, chemistry, immunology, blood bank (Donor and Transfusion Management), surgical pathology, anatomical pathology and microbiology. Laboratory Information Systems commonly support the following features: • • • • • • •
Patient Check In Order Entry Specimen Processing Result(s) Entry Reporting Patient Demographics Physician Demographics
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Radiological Information System (RIS) A radiology information system (RIS) is a computerized database used by radiology departments to store, manipulate, and distribute patient radiological data and imagery. The system generally consists of patient tracking and scheduling, result reporting and image tracking capabilities. RIS complements HIS (Hospital Information Systems), and is critical to efficient workflow to radiology practices
BASIC FEATURES Radiology information systems commonly support the following features: • • • • • • • • • • • •
Patient Registration and scheduling Patient List Management Interface with modality via Work list. Radiology Department workflow management Request and document scanning Result(s) Entry Reporting and printout Result(s) Delivery including faxing and e-mailing of clinical reports Patient Tracking Interactive Documents Technical Files Creation Modality and Material management
A picture archiving and communication system (PACS) is a medical imaging technology which provides economical storage of, and convenient access to, images from multiple modalities (source machine types). Electronic images and reports are transmitted digitally via PACS; this eliminates the need to manually file, retrieve, or transport film jackets. The universal format for PACS image storage and transfer is DICOM (Digital Imaging and Communications in Medicine). Non-image data, such as scanned documents, may be incorporated using consumer industry standard formats like PDF (Portable Document Format), once encapsulated in DICOM. A PACS consists of four major components: The imaging modalities such as X-ray computed tomography (CT) and magnetic resonance imaging (MRI), a secured network for the transmission of patient information, workstations for interpreting and reviewing images, and archives for the storage and retrieval of images and reports 43
HIS of Fortis, Noida has following Modules: OPD Billing Module IPD Billing Module Store Module House Keeping Module Nursing Module Administration Module Diet Module Medical Record Purchase Module LIS and RIS
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Cloud Computing Cloud computing refers to the delivery of computing and storage capacity as a service to a heterogeneous community of end-recipients. End users access cloud based applications through a web browser or a light weight desktop or mobile app while the business software and data are stored on servers at a remote location. These services are broadly divided into three categories: Infrastructure-as-a-Service (IaaS), Platform-as-a-Service (PaaS) and Software-as-a-Service (SaaS). Infrastructure-as-a-Service like Amazon Web Services provides virtual server instance) to start, stop, access and configure their virtual servers and storage Platform-as-a-service in the cloud is defined as a set of software and product development tools hosted on the provider's infrastructure, GoogleApps are examples of PaaS. In the software-as-a-service cloud model, the vendor supplies the hardware infrastructure, the software product and interacts with the user through a front-end portal Services can be anything from Web-based email to inventory control and database processing. Because the service provider hosts both the application and the data, the end user is free to use the service from anywhere
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A cloud can be private or public. A public cloud sells services to anyone on the Internet. (Currently, Amazon Web Services is the largest public cloud provider.) A private cloud is a proprietary network or a data centre that supplies hosted services to a limited number of people. When a service provider uses public cloud resources to create their private cloud, the result is called a virtual private cloud.
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Cloud computing of Fortis, Noida Fortis, Noida has Private cloud computing network Infrastructure as a Service - A robust data centre providing virtualized hardware and connectivity for all Fortis locations with full disaster recovery and backup infrastructure Platform as a Service - for Fortis IT and Fortis software vendors to develop, maintain, deploy and deliver software applications for various Fortis functions. Software as a Service - As part of the cloud, Fortis has centralized its Hospital Information System: Trakcare from Inter Systems and created a central analytics and MIS platform.
HOUSEKEEPING MODULE OF HIS Introduction
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Housekeeping refers to the general cleaning of hospitals and clinics, including the floors, walls, and certain types of equipment, tables and other surfaces. The purpose of general housekeeping is to: �� reduce the number of microorganisms that may come in contact with patients, visitors, staff and the community �� provide a clean and pleasant atmosphere for patients and staff. Existing House Keeping Module: Housekeeping module of Fortis hospital mainly deals with the bed status of the ward in which firstly the beds from which patient ready to move are shown and then the information through phone is being delivered to the floor supervisor about the room that has to be cleaned which is also shown in the HIS housekeeping module then when the room is cleaned the information is being passed by the supervisor to the housekeeping desk that room has been cleaned and the person attending the call mark in the HIS that the room has been cleaned and vacant and ready to be occupied by other patient. Since according to my perspective the house keeping module is very short and limited other work like laundry management is not dealt in this HIS module and staff at the department has to do extra work along with the assigned task and there is shortage of the staff also. Recommendation On the basis of existing module. Bed status to be filled by the nurse when the patient is about to move.Information of bed to be cleaned should be displayed on the screen which is to be installed in the house keeping department. The beds which are to be cleaned should be displayed on the screen just like status which is shown on the railway station showing train status. Then, through phone message is to be send to the concerned floor supervisor regarding the cleaning of the room and then the supervisor should tell to the nursing station to mark it vacant in the system. Housekeeping module should be a part of ward module. There is no need of housekeeping module it should be a part of ward module according to the existing module because it needs extra employee to be there to attend and to see the status and it is also causing delay in the work as person who is attending has to do his assign work also. Secondly, The status of the beds other then the floor wards like (micu, ccu) which is being shown on the housekeeping module should not be shown as it is to made vacant by the nurse
who is on HIS desk as it cause an extra work and extra overload on the employee and more over these beds are not under the authorization of housekeeping department. My Recommendations on New module 48
Other then the facility and options provided by the exiting HIS housekeeping module. The housekeeping module should be designed to forecast the total number of housekeepers needed each day in the future based on current guests in-house and expected arrivals/departures. For example the forecast report may indicate that a total of 124 rooms will be dirty tomorrow for a total cleaning time of 101 hours. The next day there are 214 dirty rooms for a total cleaning time of 194 hours. This information can be used to plan the work schedules of housekeepers to make sure there are not too few, or too many, housekeepers each day The housekeeping module can automatically create a cleaning schedule each day for each housekeeper based on the number of dirty rooms, estimated clean time per room, and number of housekeepers. The third major element of the housekeeping module is historical reporting. It is possible to measure the performance of each housekeeper by tracking the estimated clean time and actual clean time, as well as variance. We can also track each time a room was cleaned and by whom. For example, if a guest checks in to a dirty room, you can determine which housekeeper erroneously marked the room as clean. Other then the housekeeping module there should be laundry management module which is to merged with and called as housekeeping and laundry management module. A modified housekeeping module:
Laundry management module:
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Cash voucher and bills
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Stock ledger
The other technique which can be used to increase the efficiency and effectiveness of the
HIS is implementation of the RFID(Radio frequency identification) technique to track the location the assets and to improve the quality of the hospital services Radio Frequency Identification (RFID) is a method for remotely storing and retrieving data
using devices called RFID tags or transponders.
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Nursing Module Nursing module has been installed into IPD department. There are 5 floors in the IPD department and 2nd floor consist of all ICU’s (NICU, MICU, CTVS, SICU, LTICU etc). Each floor except 2nd floor consists of two nursing station where nursing module of HIS has been installed. Nursing Module includes nursing wards administration, patient data monitoring, nurse planner, appointment Scheduler, patients search, documentation, patient data folders. Majorly, the work of the nursing module is to enter the IP patient indent and investigation report into the HIS. Other options include return indent, indent received options, and diet scheduler and surgery procedure, and discharge tracker are also entered into it. The process flow is:
Nurse enters the patient indents which are being prescribed by the doctor into the doctor sheet of the patient file Nurse enters the prescription into the register present on the nursing station Indents are entered in the system by the data entry operator into the HIS and this information is then send to the IP or MC (medical consumable) Store Then the indents are being supplied to the nursing station. Nurse receive the indents and again the data entry operator mark as Received into the HIS. Investigation orders are also entered into HIS with same procedure and discharge intimation are also given with the ward module. Nursing module also include Diet Scheduler module in it where diet of the patients are being entered
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NURSING MODULE IS BEING CONNECTED TO THE FOLLOWING:
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Recommendations on the Nursing Module: Since Nursing module is very big and needs lots of work and attention. Nurse as we know are very important part of the hospital. Acc. To me module should be divided into two parts: Ist part contain the use of Tablet PC’s by the nurse and medical professionals which can be connected to HIS of the hospital. Tablet PC’s should be connected with each bed (one tab to one bed or two bed) Patient history and other details can be easily shown in the pc and it should be PACS and DICOM enabled to see the images of ultrasound, x-ray etc.Tablet pc will help in entering correct prescription which should be entered by doctor only to reduce medication error and patient activity sheet can be prepared. Nursing and doctor notes can also be written in the tablet PC’s. Since paper work takes lots of time and chances of error are more
ELECTRON IC MEDICAL RECORD DEPT…
Tablet pc’s will be connected to ward module which can be cut short and contains only diet module and discharge intimation process also we can view information about the patient through patient IPID. Tablet PC’s will function as doctor will enter the prescription rite from the patient 54
bed which will directly go through HIS to store department and radiological department. Tablet PC’s will contain all the patient history which will be entered into it along with DICOM enabled images viewer it will help in reducing chances of error and time. On the spot report can be generated and send to the IPD billing department for billing procedures. More info of Tablet PC’s The tablet PC is an ultimate solution for nurses and medical professionals to perform daily documentation and reference works. It offers quick wireless access to medical and drug reference, patient records and allows instant connectivity with the main database of the hospital. This tablet PC has been designed to save time and boost accuracy by eliminating paper records and has the potential to become a complete hospital solution to save countless deaths each year caused by various medical errors. The portability and use of medical software of the tablet will replace the nurse’s clipboard and increase her functionality. It will feature a touch screen interface where the user can interact with various applications and also can be docked on the table for more familiar use. Throughout the hospital there will be several docking base where the nurse can dock the Tablet Pc to recharge the battery and input data easily.
Tablet PCs allow health care professionals of all levels to be more efficient and accurate in their day-to-day activities by enhancing their ability to perform a variety of tasks, both at their desks or on the go. Examples of activities that can be improved include: • Collection and Integration of Patient Data • Patient Record Retrieval, Review and Collaboration, • Meetings • House calls and patient bedside visits • Wireless interaction among staff and physicians These activities all involve basic tasks, which are made easier by the Tablet PC. Some examples are: • Completing electronic forms or “writing” prescriptions • Taking progress notes in handwriting that can be converted to printed text • Adding handwritten notes to charts and images • Integrating several reports, such as tests and treatment plans, into one document • Sharing data via a secure wireless LAN The key features behind these benefits are: • The versatility of the Tablet PC, which allows data entry from a keyboard, a Digital pen or dictation • The Tablet digital pen for navigation and writing
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A health care worker using a Tablet PC can enter data directly into an electronic form via an Electronic Health Record (EHR). This not only saves the time previously required to fill out a paper form and then re-enter the data into a computer, but also eliminates the human error inherent in this process. When conducting examinations, patient reviews, treatments, or rounds, the Tablet PC can provide immediate access to information. Additionally, the capability to write directly on the durable tempered glass screen permits capturing useful information, such as progress notes, diagrams or images in an electronic format, and then annotating them, ensuring that no information is lost. When completed, a full report can be generated on the spot. The Tablet PC assists with document creation, editing and collaboration. The capability to write directly on the screen allows health professionals to share a broad range of Information regardless of whether it is in the form of notes, sketches, or document Annotations.
2nd part consist of ward module which will deal with diet module, bills, reports generation, bed management, patient transfer process and other process which is present on existing ward module except the one which has been covered in use of tablet PC’s to make the work easier, effective and maintaining the inflow of the patients.
Summary No need of file to maintain No loss of documents No medication error Can be effective in discharge Process of the patients Mistakes can be avoided through access to complete medical histories and by inputting information directly into electronic forms that have built-in logic to flag errors as they are entered Can save more than money—it can save lives and ensure that patients receive the best care available. Speed up the work of emergency response teams Tablet PCs could help insurance companies and health care providers by: • Responding to and closing claims more quickly • Producing more accurate claim reports • Submitting more accurate coding for correct billing • Reducing insurance fraud
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IT and Store Module 57
Health information technology IT allows health care providers to collect, store, retrieve, and transfer information electronically by providing new ways for providers and their patients to readily access and use health information. Information technology (IT) has the potential to improve the quality, safety, and efficiency of health care. Similar terms can be used to define different products, and the exact functions of a system will depend on the specifics of its implementation in a given setting. Both the terms and the functions also change over time. For example, computerized provider order entry (CPOE), which can minimize handwriting or other communication errors by having physicians or other providers enter orders into a computer system, can apply only to prescription drugs, or may also include additional physician orders, such as x-rays or other images, consultations, and transfers. For electronic health records (EHRs, also known as electronic medical records, automated medical records, and computer-based patient records, among other names) The following technologies and terms are often included in information technology in health care: • Electronic (EHR):
health
record
time diagnostic and treatment recommendations. The term covers a variety of technologies ranging from simple alerts and prescription drug interaction warnings to full clinical pathways and protocols. CDSS may be used as part of CPOE and EHR.
EHRs were originally envisioned as an electronic file cabinet for patient data from various sources (eventually integrating text, voice, images, handwritten notes, etc.). Now they are generally viewed as part of an automated order-entry and patient-tracking system providing real-time access to patient data, as well as a continuous longitudinal record of their care.
• Picture archiving and communications system (PACS): This technology captures and integrates diagnostic and radiological images from various devices (e.g., x-ray, MRI, computed tomography scan), stores them, and disseminates them to a medical record, a clinical data repository, or other points of care.
• Computerized provider order entry (CPOE): CPOE in its basic form is typically a medication ordering and fulfillment system. More advanced CPOE will also include lab orders, radiology studies, procedures, discharges, transfers, and referrals.
• Bar coding: Bar coding in a health care environment is similar to bar-code scanning in other environments: An optical scanner is used to electronically capture information encoded on a product. Initially, it will be used for medication (for example, matching
• Clinical decision support system (CDSS): CDSS provides physicians and nurses with real58
drugs to patients by using bar codes on both the medications and patients’ arm bracelets), but other
applications may be pursued, such as medical devices, lab, and radiology.
• Radio frequency identification (RFID): This technology tracks patients throughout the hospital, and links lab and medication tracking Wireless communications system. It is neither mature nor widely available, but may be an alternative to bar coding • Automated dispensing machines (ADMs): This technology distributes medication doses. • Electronic materials management (EMM): Health care organizations use EMM to track and manage inventory of medical supplies, pharmaceuticals, and other materials. This technology is similar to enterprise resource planning systems used outside of health care • Interoperability: This concept refers to electronic communication among organizations so that the data in one IT system can be incorporated into another. Discussions of interoperability focus on development of standards for content and messaging, among other areas, and development of adequate security and privacy safeguards.
Barriers to adoption Investment in IT is costly The costs of implementation and ongoing maintenance vary by the size of the hospital, as well as by the functions to be installed Resistance to change by doctors, nurses and other staff Not all staff is tech savvy, so they prefer paper work
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STORE MODULE: Store module consists of all pharmacy and inventory management process. Store module covers IP Pharmacy, Medical Consumables store, General Store, OT Pharmacy, OP Pharmacy. Process flow in IP Pharmacy
Order is being given through HIS in the form of Indents to IP store by the Data entry operator (nursing Station)
Person in the IP store checks the Indents Depending upon The type of indents (New, Stat, Normal)
Medicines are recorded, quantity is checked and the medicines are Dispatched to the respective stations
IP store mainly delivers the drugs to the IPD patients only. Other features of the IP store module consist of Purchase requisition to be given to the purchase department for new drugs to be bought which is dependent on ROQ(re order level quantity) and QOH (quantity in hand) which is shown in the HIS. Return Indents are kept which are being received by the nurse and data is entered in the HIS and it is thoroughly checked whether it infectious or not or it is broken or not if any of such problem is found out then indents are not taken back. Once the Purchase return has been entered it cannot be corrected. The only way
is to reject the IP returns in the HIS. FIFO (First in First out) method is followed in dispatching of the medicines to reduce expiry date errors.
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Medical consumables Store The Function of MC Store Module is as same as IP store but it is different in the form of delivery of Indents. IP pharmacy basically deals with the drugs and MC sore deals with the medical consumables like bandages, syringes, adhesive, solution, cotton etc. MC Store is attached with the General store also.
OP pharmacy The function of HIS in OP is different from the other stores. Here, drugs are directly dispatched to the patients on the basis of Doctor Prescription. OP store mainly deals with the OPD patients. Here, the Prescription is given by the patients to the chemist. The chemist prepares the bills and dispenses the drugs to the patients directly on the Basis of Doctor Prescription.
OT pharmacy
It is as same as IP store module.
Recommendations: The IP, MC, OT pharmacy should be connected to PC tab not with the ward module as discussed in the nursing Module so that Indents should be directly entered by the doctor on e-prescribing method through CPOE(Computerized Physician order entry) through PC tablet. So that the chances of medication error can be reduced, saving on time E-prescribing, which will allow electronic prescriptions filled by physicians to flow to both the pharmacy and the Prescription Pricing Authority that manages payments. CPOE should be implemented for OP pharmacy for less paper work and efficiency and to reduce medication errors
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Advantages of CPOE: •
reducing medication errors, including adverse drug events
• decreasing dosage errors • prescribing certain medicines more precisely •
Improve the quality of healthcare
RFID technology or bar coding technology should be implemented (more emphasis on RFID technology) to reduce ambulatory and inpatient medication error and the number of adverse drug events. RFID technology tracking the assets as medicines are one of the important assets in the hospital and it can be combined with the existing HIS of the hospital.
OPD MODULE The Outpatient Department of Fortis, Noida has a separate building for outpatients with ground floor and First floor having all the important services like TMT, Echo, ECG, Surgical OPD, Paediatric cardiology, Consultation, Executive Health Check (EHC), Comprehensive Cardiac Check (CCC), and Pharmacy. It has a lab facility in lower Basement along with a sample collection room on the ground floor. The patients collect their report from the report desk in the ground floor of OPD building. The preventive health check up is done on the ground floor with x-ray and Ultrasound in the IPD building opposite to the OPD building. PROCESS OF OPD BILLING PATIENT ENTERS INTO THE HOSPITAL
PATIENT APPROACHES THE OPD REGISTRATION DESK
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PATIENTS FILLS THE REGISTRATION FORM
INFORMATION IS ENTERED IN TO THE HIS OF THE HOSPITAL
THEN, UHID (UNIQUE HOSPITAL IDENTIFACTION) IS GENERATED
BILLS ARE PROCESSED AND NEW INVESTIGATION ORDER OR DOCTOR VISIT ARE ENTERED INTO HIS
THEN, HARD COPY
OF THE BILL IS TAKEN WHICH IS GIVEN TO
THE PATIENT FOR FURTHER PROCEEDING The Standard Support services provided in the OPD are:a) ECG Room b) Dressing Room c) Plaster Room
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This process of Registration takes 2-3 min.
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The OPD is located in the OPD building(right side to the IPD front desk)
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Co-ordinaters are there who help the patients regarding their queries
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Proper signage’s are there in the OPD department for easy flow of the patients
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A large waiting area is there near the OPD registration counter, and outside all the departments, adequate no. of chairs are placed.
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Appointment is either on Telephone or by personally coming and getting the appointment fixed.
Functional Organizational Structure (OPD) Head patient Care Services
OPD Supervisor
PHC Supervisor
Assistant Supervisor
PHC Co-ordinator
Front Office Assistant
PHC Activities: Customers appointed are scheduled for the desired PHC package & the appointment date & time is informed as per the process of booking. PHC customers are informed about the precautions they need to take fasting (12 hrs) medication etc and other information related to packages. For scheduled appointments, all concerned department (lab, radiology, NIC) are informed about the no. of appointments. Customers arrive at OPD/PHC reception as per their appointment. Clients are registered and billed As required customers are escorted to various departments like lab, radiology, NIC
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All investigation reports are compiled and appointment for final consultation with doctor is fixed.
Problems in PHC The biggest problem which faced by the PHC department is the waiting time in X-Ray and ultrasound. Patients becomes irritated as it takes long time for them for the test to be done
Interpretation: The above pie chart shows different time consumed at different places starting from the billing till the updation of final reports. The value of Turnaround Time is 4.5 hours according to Fortis Operating Systems Indicator for the package. As we can see that more time is consumed for processing and final updation of reports just after the patient gives the second sample after breakfast, so the time should be maintained in order to achieve the benchmark of 4.5 hours. 65
Recommendations: 1. Regarding the waiting time in ultrasound, it can be reduced by redirecting some patients to the other test which has to be done with fasting. Since, ultrasound and X- ray has limited machines which increase the waiting time of the patients. In the meantime they can be directed to take other test this will help in reducing the irritation of the patients and as well as improving the TAT as the patients doesn’t have to wait for test for a longer time. 2. Use of PACS and DICOM in the hospital will help in reducing the time as we have seen in the above diagram as most of the time is taken in processing of the final reports and consultation. PACS and DICOM will enable the doctor to view the reports directly into the computer which will result in fast consultation and processing of the reports will be reduced as the data of the patients will be directly linked to HIS so, there will be minimum or no use of films used in X RAY and ultrasound and they can be directly obtained from the patient UHID. 3. If patient want to see the report or want to take the report it can be printed at one station or it can be directly viewed by the patient on the website through the UHID with password given by hospital as happens in the lab report. 4. With this implementation it will help in reducing the cost incurred in the films produced and processing of that films and reports thereby reducing the waiting time. 5. Connecting the LIS and RIS with the HIS through PACs and DICOM viewer will also help in improving the threat of lost of files or reports. 6. Medical check-ups for the staff should be scheduled in the afternoon when the patient load is considerably less. 7. The last and the foremost thing for improving the waiting time is implementation of the RFID technique for patient tracking Active RFID-RTLS patient tracking and transport applications are being used to improve patient flow in hospital. These patient tracking systems can provide data which have significant effect on improving patient tracking, patient flow and provide valuable insight into patient flow improvements that can impact patient care. For example, patient tracking and patient flow applications can:
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• • •
Measure patients waiting longer than 15 minutes for triage Detail the percentage of patients waiting longer than 15 minutes Determine lab turnaround times to hold them accountable.
Other Recommendations: Medical record department should be made electronic ( Implementation of the electronic medical record) which will help to ◦
Improve quality and convenience of patient care
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Increase patient participation in their care
◦
Improve accuracy of diagnoses and health outcomes
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Improve care coordination
◦
Increase practice efficiencies and cost savings
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Implementations of RFID will help in improving the effectiveness and in providing quality care to the patients. RFID will help in Patient Identification Many health professionals are concerned about the growing number of patients who are misidentified before, during or after medical treatment. Indeed, patient identification error may lead to improper dosage of medication to patient, as well as having invasive procedure done. Other related patient identification errors could lead to inaccurate lab work and results reported for the wrong person, having effects such as misdiagnoses and serious Medication errors In order to cut these clinical errors, to improve patient care and security and also to improve administration and productivity, RFID-based patient identification and tracking systems should be implemented Blood Tracking RFID system should be there to track the blood going from the blood bank Anti-Counterfeiting Drug counterfeiting is an increasing problem: counterfeit drugs reduce patient safety, as they can contain dangerous substances. RFID technology should be used in tracking the drugs and labeling of the drugs so that the product codes can be retrieve and product authenticity can be checked
FORTIS Hospital Information System—The Future Fortis has become the First Healthcare Company in India to Undertake Complete Outsourcing for IT Applications and Infrastructure Management. This deal will pave way for Enhanced Efficiencies and Patient Care
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HCL Info systems Ltd, India’s premier information Integration Company and Fortis Healthcare Ltd, on September 2009, announced a strategic IT outsourcing deal. The deal is part of a five year agreement under which HCL will undertake complete outsourcing of IT systems and processes of Fortis Healthcare Ltd. Fortis, Noida will be operating on Trak care – a complete Hospital Information System (HIS) solution. This is a totally web-based system connected to centralized server. Different modules like BILLING which is used in OPD and IPD for patient billing, PHARMACY which is used for dispatching medicines and medical consumables to outpatient and inpatients, INDENTING module is used by nurses for indenting medicines to the patients. DISCHARGE SUMMARY modules used for making discharge summary of patients, which is integrated with their LMS server for lab reporting. The Pathology Lab for all inpatient and outpatient lab reports uses LMS. The finance module is based in Prodigious, which is completely integrated with Trak modules for all MIS and other reporting purposes. This tie up will create newer benchmarks in the quality of healthcare delivery and patient care and take it to the next level. IT forms the back bone for hospital operations and improved patient care. The system integration with high end IT infrastructure would result in enhanced performance and superior patient care.
Data Flow Diagrams The following diagrams are showing the total process flow in the hospital right from the beginning when patients enters into the hospital till he discharges pays the bill and go out of the hospital.
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Level 0
70
Level 1
71
Level 2
72
Level 3
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Conclusion: It can thus be seen that deploying IT 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. They can perform the complex task of matching, tabulating, calculating, retrieving, printing and securing the data as required. Well designed, integrated computer system can be a great tool in the hands of the hospital management in improving services, controlling cost, and ensuring optimal utilisation of facilities.
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Bibliography 1. 2.
www.wikipedia.com http://www.hp.com/sbso/busproducts_notebooks.html
3.
www.rfidjournal.com/article/articleview/319/1/1/.
4.
IIE Solutions. Florida Airport Gets First RFID System. July 2002
5.
www.hospitalinformationsystem.com
6. 7.
www.wikinvest.com/concept/Cloud_Computing www.cdac.in http://www.scribd.com
8.
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ANNEXURE A
S.No.
Department
Date of visit
time spent
People met
1
LABORATORY
3 MAY 2012
30 MINUTES
Mr. Kumar( Lab Manager)
2
CSSD
7 MAY 2012
25 MINUTES
Mr. Raj Kumar(HOD)
3
EMERGENCY
10 MAY 2012
45 MINUTES
Dr. O.P Choudhary( ER Head)
4
ICU
18 MAY
20 MINUTES
5
Blood Bank
23 MAY
20 MINUTES
Dr. Seema ( HOD)
6
OT
29 MAY
1 HOUR
Sister Anitha
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