HMIS Chapter on Hospital Information Systems

CHAPTER III – HOSPITAL INFORMATION SYSTEMS
MH-204: HMIS Slide 1

Healthcare is changing…
Today Tomorrow
Scope Cure Patients Care for Citizens
Focus On the process and provider On the patient
Time Symptomatic, curative Preventive, lifetime
Location Hospital Decentralized, at home
Methods Invasive Less invasive

Processes are changing …
Today Tomorrow
Clinical
Decisions Personal preferences Guide lines / evidence based
The Process Fragmented, isolated disease mgt.
Experience Individual Best Practices
Order Process Manual Automated
Information Fragmented, isolated Consolidated / complete

IT is changing …
Today Tomorrow
Technology Isolated systems Integrated systems
Data access Limited, Difficult Any time, any place
Data integrity Manual/error prone Systematic mgt. and control
Data Fragmented Consolidated

completeness
Data availability Slow Real time

The Hospital
High Quality
Cost Effective
Medical Knowledge
Activities needs Assessment needs Information
produces

Definition And Purpose Of Hospital Information Systems
A Hospital Information System (HIS) is a computerized system

designed to meet the information needs of all (or most) of a
hospital. This includes many diverse types of data, such as:
Patient information
Clinical laboratory, radiology, and patient monitoring
Patient census and billing
Staffing and scheduling
Outcomes assessment and quality control
Pharmacy ordering, prescription handling, and pharmacopoeia
information
Decision support
Finance and accounting
Supplies, inventory, maintenance, and orders management

Definition And Purpose Of Hospital Information Systems
Hospital Information System. One that supports all hospital functions

and activities such as patient records, scheduling, administration,
charge-back and billing, and often links to or includes clinical
information systems such as RIS. (Radiology Information System )
that part of a HIS in which computer systems are used as ICT-tools

(information and communication technology ) is referred to as its
computer-supported part
the remainder is being referred to as the
non-computer-supported part
as a consequence, a hospital has a HIS from ...
the beginning of its existence on

WHY HIS ?
the question is not

whether a hospital should be equipped with a hospital information
system or not,
but an appropriate question would be ...

whether the performance should be enhanced, for example, by
using state of the art ICT-tools
HIS must consider all areas of a hospital:

wards
outpatient units
service units (diagnostic, therapy, others)
administrative departments
management/executive units

PLAYERS ?
HIS must consider all groups of persons

physicians
nurses
administrative staff
technical staff
health informaticians / health information managers
...
... and last, but not least,

patients
visitors
suppliers
...

HIS
“an integrated effort to collect, process, report and use health

information and knowledge to influence policy-making, programme
action and research ”
WHO (2000) Guidance on Needs Assessment for National Health

Information Systems Development.
“a set of interrelated components working together to gather,

retrieve, process, store and disseminate information to support the
activities of health system planning, control, coordination and decision-
making, both in management and service delivery”
Jack Smith, in:Health Management Information Systems – a handbook

for decision makers. OUP, 2000.

HOSPITAL INFORMATION SYSTEM
Registration Consulting Ward Nursing

Stores & Purchase
Diet & Kitchen

Pharmacy
And more...
OT Blood Bank Laboratory Radiology

ADVANTAGES OF HOSPITAL INFORMATION SYSTEM
Increased time nurses spend with patients

Access to information
Improved quality of documentation
Improved quality of patient care
Increased nursing productivity
Improved communications
Reduced errors of omission
Reduced medication errors
Reduced hospital costs
Increased nurse job satisfaction
Development of a common clinical database
Improved patient's perception of care
Enhanced ability to track patient's record
Enhanced ability to recruit and retain staff
Improved hospital image

Investment in HIS may result in many benefits (WHO):
helping decision makers to detect and control emerging and

endemic health problems, monitor progress towards health goals,
and promote equity;
empowering individuals and communities with timely and

understandable health-related information, and drive improvements
in quality of services;
strengthening the evidence base for effective health policies,

permitting evaluation of scale-up efforts, and enabling innovation
through research;
improving governance, mobilising new resources, and ensuring

accountability in the way they are used.

HIS in health services planning
How will we know when

Where are we now?
we get there?
♦ Identification of needs and
♦ Monitoring and evaluation
problems
♦ Choice of appropriate
indicators
Pervasive role
of information
How will we get there?

♦ Development of Where do we want to go?
interventions ♦ Setting priorities and targets
♦ Identification of resources
14
What kind of data flow in a HIS
birth, morbidity and mortality data
type and location of health personnel
type and quality of clinical services provided at national and sub-national

level
population indicators
demographics and socio-economic status
This data can be organized in 5 domains.

Domains of health data
• health determinants
• health system inputs
• health system outputs
• health system outcomes
• health status.

Types of Health Care Data
Patient-Specific Data
Clinical Data
Administrative Data
Financial and Billing Data
Aggregate Health Care Data
Disease and Procedure Indexes
Medicare Cost Reports
Health Care Statistics
Outcome Measures and Balanced
Scorecards

Typology of measurement domains in health care
Figure 2 Typology of measurement domains
Health
determinants
Risk factors
Behaviours Health
Genetics status
Environment
Health
system Mortality
Socio-economic &
demographic outcomes
Morbidity /
disability
Health Health Well-being
system system Service
inputs outputs utilization
Policy Information
Financing Service
Human availability and
resources quality
Organization

Information of a hospital come from
Front office
Doctors consultation room
Ward
Laboratory
The service providers like financial and
insurance service provider
And so on

This information can be categorized as

Types Of Hospital Information System
Hospital Information Systems come in many flavors, depending on whether

they are based on...
centralized or decentralized plans
software that was originally business-oriented or patient-oriented
terminals or workstations

Centralized vs. Decentralized
This distinction is based on whether information is kept primarily in a central

computer, or is distributed over a number of workstations or servers located around
the hospital.
There are variations on this; for example, a system may be partially centralized but
integrated with powerful and somewhat independent satellite systems.
Examples:
Some systems may centralized certain functions like billing and accounting in
an administrative facility serving several affiliated hospitals, while other functions
like patient record-keeping are carried out at the individual hospitals or medical
units.
Other systems may centralize their patient record-keeping and have smooth
exchange of information with a specialized clinical laboratory computer system
which is mainly independent of the primary HIS.

Business Oriented vs. Patient Oriented
Though both these types of systems handle patient information, the

orientation of the original designers may affect the procedures and general
"character" of a HIS.

Terminal vs. Workstation Oriented
Terminals and workstations are computer devices that often look very similar: both
usually have a keyboard and a CRT display screen, and are often confused with one
another.
What's the difference?
Terminals are electronic devices that let humans communicate with a computer. They
are generally connected to minicomputers or mainframes, which could be close by or
halfway around the world. They may have some minor processing power of their own,
but are generally not able to do anything if not attached to a (functioning) computer.
Workstations are computers designed for professional use by one person at a time.
They are fully functional computers on their own, but they can be networked to other
workstations, mainframes, or minicomputers. (The term workstation can refer to any
personal computer, but is often applied to specially powerful microcomputers.)

Terminal vs. Workstation Oriented
Terminal-oriented systems are by nature very centralized, since the terminal can't do
anything on their own.
Workstation-oriented systems can be either centralized or decentralized, because the

processing power of the workstation gives system designers a lot of flexibility.
The trend in most types of computer work is toward decentralization, but this trend is
somewhat slower in hospitals because of the high risks associated with failure in
hospitals and the consequent reluctance to change systems that are working now.

PROCESS MANAGEMENT IN HEALTHCARE
Rising medical costs, industry consolidation, changes in social culture and government
legislation are driving the need for changes in the delivery, administration and
management of healthcare.
Healthcare service providers will find it increasingly difficult to perform or even

compete on a cost / service basis, and satisfy new service demands with often
decreasing resources.
In order to accomplish and improve healthcare services, providers must integrate,

automate and optimize critical functions, information and healthcare processes.
Introducing process management shifts the perspectives from a functional orientation

towards a process viewpoint, and thus change the way healthcare service providers
operate
Process management has emerged as a catalyst to assist healthcare service providers

in increasing efficiency and effectiveness of their services.

CORE PROCESSES HEALTHCARE
These processes must be flexible enough to

suit real, practical healthcare activities so
that the following aims can be achieved:
• Patient focused and transparent care.
• High quality of care.
• Quality monitoring of each patient’s care.
• Efficient care services
• Predictability and control of changes.
• Measurement of effectiveness and cost-

benefit of care.
• Benchmarking (nationally and

internationally).

Classifying performance indicators and healthcare process development
Operations: measures the value of the current process performance.
Current Strategies: understanding and evaluation of how the process

implementation is aligned and contributes to current strategies.
Opportunities: determine the potential future value of the existing process

structure.

Classifying performance indicators and healthcare process development

Some outcome Variables that can be used for HIS
Evaluation
1. Median Time Outpatients spend at hospital.
This is an overall indicator of the efficiency of outpatients, as well assessing some

aspects of effective transfer between clinics within the hospital.
2. Length of Stay.
This is an indicator of administrative efficiency and clinical effectiveness.
3. Bed Occupancy.
This an indicator of bed utilisation, administrative efficiency and clinical

effectiveness.
4. Number of drug prescriptions per patient.
This is a measure of clinical effectiveness and efficiency.

Outcome Variables used in HIS Evaluation
5. Improved Revenue Collection
Indicator of hospital income and of the efficiency of the hospital’s financial management.
6. Cost Per Patient Per Day (CPPPD).
This is a variable which measures average patient daily costs, which enables the
monitoring of units costs over time.
7. Number of Referrals
This is a measure of clinical efficiency and cost.

Other examples

Other examples

HMIS Chapter on Hospital Information Systems

Hochgeladen von

Dokumentinformationen

Originalbeschreibung:

Originaltitel

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

HMIS Chapter on Hospital Information Systems

Hochgeladen von

Copyright:

Verfügbare Formate

CHAPTER III – HOSPITAL INFORMATION SYSTEMS

MH-204: HMIS Slide 1

Scope Cure Patients Care for Citizens

Focus On the process and provider On the patient

Time Symptomatic, curative Preventive, lifetime

Location Hospital Decentralized, at home

Methods Invasive Less invasive

MH-204: HMIS Slide 2

The Process Fragmented, isolated disease mgt.

Experience Individual Best Practices

Order Process Manual Automated

Information Fragmented, isolated Consolidated / complete

MH-204: HMIS Slide 3

Technology Isolated systems Integrated systems

Data access Limited, Difficult Any time, any place

Data integrity Manual/error prone Systematic mgt. and control

Data Fragmented Consolidated

Data availability Slow Real time

MH-204: HMIS Slide 4

MH-204: HMIS Slide 5

A Hospital Information System (HIS) is a computerized system

MH-204: HMIS Slide 6

Hospital Information System. One that supports all hospital functions

that part of a HIS in which computer systems are used as ICT-tools

the remainder is being referred to as the

as a consequence, a hospital has a HIS from ...

the beginning of its existence on

MH-204: HMIS Slide 7

the question is not

but an appropriate question would be ...

HIS must consider all areas of a hospital:

MH-204: HMIS Slide 8

HIS must consider all groups of persons

... and last, but not least,

MH-204: HMIS Slide 9

“an integrated effort to collect, process, report and use health

WHO (2000) Guidance on Needs Assessment for National Health

“a set of interrelated components working together to gather,

Jack Smith, in:Health Management Information Systems – a handbook

MH-204: HMIS Slide 10

Registration Consulting Ward Nursing

Diet & Kitchen

OT Blood Bank Laboratory Radiology

MH-204: HMIS Slide 11

Increased time nurses spend with patients

MH-204: HMIS Slide 12

helping decision makers to detect and control emerging and

empowering individuals and communities with timely and

strengthening the evidence base for effective health policies,

improving governance, mobilising new resources, and ensuring

MH-204: HMIS Slide 13

How will we know when

How will we get there?

birth, morbidity and mortality data

type and location of health personnel

type and quality of clinical services provided at national and sub-national

demographics and socio-economic status

This data can be organized in 5 domains.

MH-204: HMIS Slide 15

MH-204: HMIS Slide 16

MH-204: HMIS Slide 17

Figure 2 Typology of measurement domains