Information Technology in Hospitals

1. HOSPITAL
IT DEPARTMENT
DR SANDEEP MOOLCHANDANI

2. What is health information
technology?
• New ways for providers and their patients
to readily access and use health
information
• “IT allows health care providers to collect,
store, retrieve, and transfer information
electronically”
• Information technology (IT) has the
potential to improve the quality, safety, and
efficiency of health care

3. A well developed IT Department
should have following Four Functional
Units
• Computer Services
• Project Management Team
• Information Technology
Application Support and Training
Department
• Web Services

4. Computer Services
• Helpdesk.
• Technical Support
• Networking (Networking encompasses both data
and telephony requirements)
Project Management Team
• Projects undertaken range from the planning and
implementation of major new systems such as a
Patient Administration system through to more
specialised clinical database systems

5. Information Technology Application Support
and Training Department
• Training in the use of these systems, as well as
offering first line support should any problems
arise whilst the system(s) are being used
Web Services
• The Web Services department
maintains, supports, and promotes web based
Information Technology systems

6. Benefits Achieved From a Well
Developed IT Department and IT
System in a Hospital

7. Benefits Achieved From a Well
Developed IT Department and IT
System in a Hospital
1. Patient Monitoring: With the help of a
computerized system we can react
much more quickly and accurately
2. Reduction of errors in patient care
3. Keeping detailed medical records for
National and International Medical
Studies
4. Assisting the physicians in medical
diagnosis

8. Benefits Achieved From a Well
Developed IT Department and IT
System in a Hospital
5. Freeing skilled medical professional (clerical work is
reduced for nurses; as much as 25% time can be
saved)
6. Training hospital employees in a better and
interactive way
7. Coordination in emergency situations (These
systems have knowledge of location of all important
equipments supplies and personnel, we can refer
the system and respond in a better way)
8. Control of increase in the cost of information
processing

9. Benefits Achieved From a Well
Developed IT Department and IT
System in a Hospital
A well controlled inventory system
can bring in savings of 10 to 15
per cent in the first year
itself, thereby justifying the
investment for a HIS product in
big hospitals

10. Main Categories of Information
Systems in Hospital
• Administrative and financial systems that
facilitate billing, accounting, and other
administrative tasks;
• Clinical systems that facilitate or provide input
into the care process;
• Infrastructure that supports both the
administrative and clinical applications.

11. IT Applications can be used in
following areas
1. Communication of Medical Information
2. Assistance in diagnosis
3. Assistance in evaluating prognosis
4. Patients Profile
5. Administrative Support
6. Medical research
7. Legal requirements
8. Linkage with other specialized computers

12. IT Applications can be used in
following areas
9. Inventory management
10.Cost control, billing
11.Maintaining medical records
12.Patient Counselling
13.Medical Literature Archival
14.Image archival and processing
15.Interactive learning and CME

13. Computers in Hospital Administration
• Helps to take quick and efficient
decisions
• Key to controlling costs and
improving the quality of patient care

14. Computers in Finance and Accounts
Department
This department uses computer for
– Payroll Accounting
– Accounts Payable
– Hospital Billing
– Cash Flow Projections
– Inpatient register

15. Computer in HR Department
• Helps organization to combine Human
resource information into a single database
• Enables the HR dept to take a more active role
in Organizational planning
• Facilitates the easy storage and access of
Personnel records
• A payroll prepared manually takes 10 days
while with help of a HRIS, it can be done in 2
Days

16. Current status of health
information technology in hospitals
across INDIA

17. Current status of health information
technology in hospitals across INDIA
• We lag behind by decades, as USA even in
1972, 81% of the hospitals had one or more
in-house computers.
• Today it is a norm in USA to allocate 10% of
the hospitals budget for computerization

18. Current status of health information
technology in hospitals across INDIA
• The current healthcare system in India is in a
state of transition
• This transition is
– Technological: For eg- from paper based patient
medical records to electronic patient medical
record
– Organizational: The transfer of activities from
Hospital care to ambulatory care (day care surgical
centers)

19. All India Institute Of
Medical Sciences, New
Delhi
It has around 2,500 indoor beds with over
1.5 lakhs admissions per annum and an
annual out-patient attendance of around
20,00,000 patients.
Advertisement for computerization of
AIIMS

20. All India Institute Of
Medical Sciences, New
Delhi
It signed a deal with Siemens Information
Systems for a 22 month project to
implement a complete hospital-
management system. Plans to offer
telemedicine service are also on the way.
Satellite links to various hospitals in
Lucknow and Chandigarh have already
been established.
Inputs from Dr R S Tyagi, Dy Dir and Head
Computer Facility and Dr G S Rao, Dept of
Biophysics

21. Tata Main
Hospital, Jamshedpur
BENEFITS
KEY PERFORMANCE INDICATORS
TMH is a 850 bedded hospital equipped
with modern facilities and catering all
specialities. Effective HIS has
helped TMH administration in achieving
and fulfilling their quality objectives

22. People International
Hospital, Bhopal
3 Units
PEOPLE’S HOSPITAL
(742 bedded teaching
hospital), Bhanpur, Bhopal
PEOPLE’S GENERAL HOSPITAL
(100 bedded), Berasia Road, Bhopal
PEOPLE’S GENERAL HOSPITAL – HI-TECH
DIVISION
(100 bedded), Opp.Raj Bhavan, Bhopal:

23. People International
Hospital, Bhopal
The IT department of the group is one of
the best departments and around 30
employees are working full-time in the
department. The team capable of
developing its own software and presently
the medical college is running with the in
house software developed by its own
promising IT team. The new hospital will
have paperless record system and will be
well connected with the foreign
hospital(Kinder Group, Singapore) in terms
of diagnostic services and other technical
aspects

24. A 1000 bedded Government teaching
Goa Medical Hospital. The hospital has been
College, Bambolim, G computerized recently. It marks the
oa completion of the first phase of a
comprehensive Goa Health Net Plan
covering other government medical
Institutes in Goa, two district
hospitals, 36 rural and urban
hospitals and 19 primary health
centres across Goa

25. Government
Hospital, Gandhinagar
HMIS proved so successful in Gandhinagar,
that the Gujarat government scaled up the
initiative to cover all 25 district-level
hospitals along with six other major
hospitals in the State. All government-run
hospitals are now connected to the State
Health Commissionerate and the
Secretariat in Gandhinagar. This not only
makes for greater accountability and
transparency, but also facilitates prompt
and vital policy decisions to tone up the
hospital administration and improve
health services.

26. SMS Hospital, Jaipur
“e-Sushrut”- C-DAC’s Hospital
Information Management System is a
complete ERP solution for Hospitals
or a chain of Hospitals. A tripartite
agreement was signed on 10 Dec.
2007, between Rajasthan
Computerisation (RajCOMP)- A
society of Government of Rajasthan
, Sawai Man Singh Hospital (SMS) and
C-DAC Noida to computerize the
State Government Hospitals.
The first hospital to get computerized
as part of the state level heath
computerization is SMS Hospital, the
biggest hospital of the state located
in the capital city Jaipur having
approximately more than 2000 beds
& 5000 patients hits every day in the
Out Patient Department (OPD)

27. The ambitious plans of ISRO (Indian
Space Research
Organization) envisage connecting
almost all the major
hospitals in the country and in the
next three years having
even a dedicated health satellite.

28. Some terms and
technologies you
should know
about

29. Electronic health record (EHR):
• EHRs were originally envisioned as an
electronic file cabinet for patient data from
various sources (eventually integrating text,
voice, images, handwritten notes, etc.).
• Include automated order-entry and patient-
tracking system providing real-time access to
patient data, as well as a continuous
longitudinal record of their care.

30. Computerized provider order entry
(CPOE):
• CPOE in its basic form is typically a medication ordering system
• Also include lab orders, radiology
studies, procedures, discharges, transfers, and referrals
• CPOE significantly reduced (by 55 percent) serious medication
errors (Bates et al. 1998)
• Of the 11 most rigorous studies, at least 1 study showed that CPOE
improved quality and safety through one of the following actions:
– reducing medication errors, including adverse drug events;
– decreasing dosage errors;
– prescribing certain medicines more precisely; or
– prescribing with improved accuracy by faculty and residents
(Oren et al. 2003).

31. Clinical decision support system
(CDSS):
• CDSS provides physicians and nurses with real-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
• A 1998 review of the literature on the impact of 68 computer-
based CDSS showed a beneficial impact on processes of care
in 43 out of 65 studies and a positive impact on patient
outcomes in 6 out of 14 studies (Hunt et al. 1998)

32. 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,
– Disseminates them to a medical record, a clinical data
repository, or other points of care
• PACS can lower costs for acquiring and storing films by
storing digitized radiology images, and may reduce the
workload among radiology staff (Wiley 2003)

33. Bar coding:
• An optical scanner is used to electronically capture
information encoded on a product.
• Initially, it will be used for medication (for example,
matching 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
• Studies document that bar coding reduced ambulatory and
inpatient medication error and the number of adverse drug
events (Oren et al. 2003, Bates and Gawande 2003, GAO
2003)

34. Radio frequency identification (RFID):
• This technology tracks patients throughout
the hospital, and links lab and medication
tracking through a wireless communications
system. It is neither mature nor widely
available, but may be an alternative to bar
coding
Automated dispensing machines (ADMs):
• This technology is used in case of drugs which
need closed monitoring while delivery
• Eg: Digoxin, Adrenaline, NTG etc

35. 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

36. 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

37. Telemedicine:
• Telemedicine is a system of health care delivery in
which physicians examine distant patients through the
use of telecommunications technology
• Before transferring serious patients to Central Hospital
where much specialised treatment can be given, from
the remote areas, medical staff at the hospital, through
X-ray pictures etc can receive information in regard to
the patient which in turn enable to prepare for the
oncoming surgical operation etc.

38. Medical Transcription
• Accurately transcribing medical records dictated by doctors and other medical
professionals
• Includes
– patient history and physical reports,
– clinic notes,
– office notes,
– operative reports,
– consultation notes,
– discharge summaries,
– letters, psychiatric evaluations,
– laboratory reports,
– x-ray reports and pathology reports and other similar kinds medical
records.
Medical transcription may be carried out for any medical professional operating
out of a small clinic or a large hospital. These transcribed records are used for
purposes of archives, reference or for serving as a legal proof of medical advise

39. Conversion from Paper Records to
Computerized Records: Some
Considerations
3 available options:
1. Summarizing the ‘active’ old record and entering
it into the computerized medical record
2. Converting the existing paper record into digital
pictorial format by means of a scanning device
3. A combination of both
Which choice is made depends upon the policy of
the hospital

40. HIS Design Considerations
• Form a design team consisting of Functional
managers and MIS experts
• Analyze the information needs of the hospital
• Set objectives and desired characteristics for
an integrated HIS
• Design systems major characteristics

41. System Development Life Cycle
1. Definition Phase: Functional requirements
and constraints are defined
2. System Design:
• System Architecture
• Conceptual Database Design
• Development and Implementation

43. Take home
message

44. Garbage in
garbage out

45. Computerization is
the need of the
present but
compulsion of the
future

46. Computers in an
organization are
tools for problem
solving and not a
solution by
themselves

47. Return

48. Return

49. RETURN

50. Drivers of adoption
• Hospitals consider both financial return on
investment and nonfinancial benefits when
making IT investment decisions
• Competition to increase quality and lower
costs

52. Barriers to adoption
• Investment in IT is costly and must compete with
other priorities, including investment in bricks and
mortar, as well as in technologies with more direct
application to clinical care and greater certainty for
increased revenues, such as new imaging equipment
• The availability of capital for investment in IT
depends, of course, on hospitals’ ability to access
capital in general, which may be easier for some
hospitals (e.g., those with good financial
performance, for profits, members of chains) than
others

53. Problems with Information
Technology Systems
• Computerization involves access to the data by all the users
• Additional protection from corruption and unauthorized
access must be taken
• For more sensitive data, more than one password can be
used
• The hardware needs protection from sabotage
• Access to main computer machine should be limited
• Malfunction problems need to be carefully monitored
• Airborne dust, humidity, temperature variations and
electrical fluctuation should be taken care of
• Technology becoming obsolete (extract as much utility in
the life span)

54. THANK YOU