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A PROJECT REPORT ON HOSPITAL MANAGEMENT SYSTEMS

SUBMITED BY SAIKIRAN.M ROLLNO: 10-37 1

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ACKNOWLEDGEMENT

The satisfaction that accompanies that the successful completion of any task would be incomplete without the mention of people whose ceaseless cooperation made it possible. Whose constant guidance and encouragement crown all efforts with success. We are grateful to Ms. Zeba and Ms. Shaista Akbar for the guidance and suggestions that helpful in the preparation of this project. I also thank my friends and college faculty who have helped in successful completion of the project.

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TABLE OF CONTENTS

S no 1. 2. 3. 4. 5. 6. 7.

Contents ABSTRACT INTRODCUTION HMS BENFITS WHY COMPUTERS IN HEALTH CARE DOCTORS DILEMMAS LAN STATEMENT OF PROBLEMS AND OBJECTIVES METHODOLGY OBSERVATION AND DISCUSSION SUGGESTED MODULES

Page nos 4 5-6 7 8 9 10 11

8. 9. 10.

12 13-19 20-37

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ABSTRACT

Hospital management System (HMS) is vital to decision making and plays a crucial role in the success of the organization. Computerization of the various departments, documentation has resulted in efficient data management and information dissemination for the users. Managers, Clinicians and other healthcare workers can now access the information without delay or errors. Present study reveals, the existing system requires up gradation to meet the requirements of the managers and the clinicians. Participants feel HMS assists in decision making, and medical audit. Participants felt that the existing HMS resulted in longer time for OPD consultation and delay in investigation results. Majority of the participants feel that HMS helps in education and research.

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HOSPITAL MANAGEMENT SYSTEM (HMS)

A management system in a Hospital would require to very precise and must result into cost cutting and efficient management. Which should be accurate in its approach and suit all environments including large, medium or small.

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INTRODUCTION SYSTEM (HMS)

TO

HOSPITAL

MANAGEMENT

Designed to improve the quality and management of clinical care and hospital health care management in the areas of clinical process analysis and activity-based costing. HMS enables you to develop organization and improve its effectiveness and quality of work. Managing the key processes efficiently is critical to the success of the hospital. HMS consist process management tool elements: modeling, analysis, and simulation. Documentation though an important part of a Hospital, is a non-productive exercise for the intellectual human being, whose ability lies in core areas of excellence. Hence a systematic approach to the way documents are managed, can transform your Hospital resources to its highest utility and advantage.

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HMS Benefits:

Enables hospitals and doctors to better serve their patients. Improved quality of patient care. Increased nursing productivity reducing the time spent by staff filling out forms, freeing resources for more critical tasks. Better quality of care, procedures and service to Patients. Control over the costs incurred by diagnosis-related groups.

Why computers in health care systems?

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There is hardly any area today, which has not been influenced by computers, and health care systems are no exception. Health sector, in fact is field where computers could make maximum social impact. There are human beings today who are half computers and half human e.g. patients with Pacemaker, Computerized precision made artificial heart, computerized hearing aid, and computerized dialysis machine. The present day hospitals are able to understand the complex processes and manage materials, money and manpower effectively and efficiently only due to computers. 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. I wonder if any hospitals management in India would do so?

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Doctor's Dilemmas
Nothing on this earth is more complex than the human body the processors used in the most powerful super computers doesnt come close to matching any of the human organs. Doctors can understand the human body, but are afraid/hesitant in using computers. This hesitancy/phobia/fear/lack of awareness is the main hurdle in the utilization of computers in health. The awareness amongst health professionals has certainly increased over the past few years but still many continue to shy away from computes - some are hesitant, some are unsure about their utility and quite a few procure it for a status symbol. Applications in health Wide applications of computers in health care include hospital management, patient care, billing, counseling, appointments, curriculum planning, research, study, communication etc. Most of the diagnostic instrument e.g. X-rays, CAT scan, Blood gas analyzers, ultrasound, automatic analyzers are based on computers, and have made the monitoring of patients and interpretation of diagnostic tests easy. It is not uncommon to see qualified professionals being utilized in clerical tasks for maintenance of records etc. at the cost of patient care. Computers could help solve some of the problems like: 1. Relieving physicians from routine documentation and other clerical functions. 2. Cutting down on the paper work; sparing more time for patient care, reducing errors and increasing accuracy in transmission and storage of data. 3. Establishment of consistent standards and continuous monitoring or transactions 4. Easy and direct access to various information regarding patient through remotely located terminals.

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Local Area Networking (LAN)

Has made Hospitals Management System easy, fast, accurate and comfortable. The patient's data, x-rays, sonograms, CT Scans and other investigation reports can be brought to the terminals in the operations theatres, patients' bed, the consulting room or the desk of administrators, just at the press of a button. In the hospitals and medical related organization the computers can be utilized through LAN for a. Communication of Medical Information b. Assistance in diagnosis c. Assistance in evaluating prognosis d. Patients Profile e. Administrative Support f. Medical research g. Legal requirements h. Linkage with other specialized computers i. Inventory management j. Cost control, billing k. Maintaining medical records l. Patient Counseling m. Medical Literature Archival n. Image archival and processing

As 75% of the activity of hospitals is concerned with the processing of information. Computers can help improve the efficiency of this information processing that too at low cost. 10

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Statement of the Problem:

A study on Computerization of

Departments of a tertiary care teaching hospital with

special reference to the Hospital Management System.

Objectives:
1. To study the existing Hospital Management System. 2. To identify the shortcomings, if any, in the existing Hospital management System. 3. To suggest the necessary steps to improve the existing Hospital Management System.

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Methodology:
The study was conducted in 1050 bedded tertiary care teaching hospital. The Whole Departments of the hospital was studied for assessing the Hospital Management System. Descriptive research approach as adopted for this study. Descriptive statistics have been used to find out the deficiencies, if any, in the existing Hospital Management System. The target population consisted of managers, doctors and patients in the hospital. The data were collected from a sample of 50, consisting of 5 managerial heads, 5doctors and 20 patients,10 administrative staff selected by the disproportionate stratified sampling technique. The inclusive criteria for selecting the sample, were the managers who involved in decision making process, doctors with experience of more than one year, and the computer literate patients, willing to participate in the study. The tool used to collect the data was a structured, closed ended questionnaire. The questionnaire was constructed with emphasis on the content, clarity and simple language. The scoring has been given according to the nature of the questions.

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Observation & Discussion:

It was observed that the complete Hospital management system has been not utilized. Having so many resources the hospital people are following the same old technique of manual writing of records. The staff who are using the computers to do their daily work are not well trained which is causing delay in time. The storage of the manual records is a big problem the data which is written in them cannot be accessed easily. The staff is willing to do their work with the use of computers , which will save their time and chance of doing mistakes is minimal which is very high in case of manual work. The department should be provided with the computers and the essential software required to their work and necessary training should be provided. The staff who are using the present software Aristotle Medics are well satisfied with the package what they are using, because they got habituated to their work and they doesnt want any change.

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THE INFORMATION OR MODULES AVAILABLE IN ARISTOTLE MEDICS WHICH IS PRESENTLY USED IN OHRC INCLUDE

Current Bill amt of admitted patients, amt. recd. and balance amt. HR Administration management, Asset management, Ward Management, Public Relation, Marketing, Special Tools & Controls. Patients : Patient gets immediate attention, A complete history for the proper selection of treatment. Patient history, Disease, complaint, medication wise, clinical report: includes tabular charts & graphs. Pre entered complaints, Doctor : general & systemic examination, diagnostic & medicine templates. In-Patient reading to pay attention to Patients without visiting any dept. even from remote locations. Easy preparation of Discharged Summary. Nurses : Nurse chart acts as worksheet for all activities & take inputs to maintain the clinical records. Automatic generation of indoor patients bill which includes establishment, Accounts : nursing, consultant, service, pathological etc. charges, complete accountancy up to balance sheet, Investigation Book, Requisition Book, OPD Register. Reception: Admitted patient list with referred by information, Patient Other staff : Registration / Bed Allocation / Pathology / Radiology / O. T. Records / Pharmacy stores.

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WHAT IS BEING ACTUALLY USED BY OHRC

ADMINISTRATION: Current Bill amt of admitted patients, amt. recd. and balance amt, Discharge process.

Automatic generation of indoor patients bill which includes establishment, Accounts : nursing, consultant, service, pathological etc. charges, complete accountancy up to balance sheet, Investigation Book, Requisition Book, OPD Register.

Reception: Admitted patient list with referred by information, Patient Other staff : Registration / Bed Allocation / Pathology / Radiology / O. T. Records / Pharmacy stores.

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Table 1 Due you think that their is need of computerization of departments .

No of respondents (n =50) Doctors Managers

Yes 4 5

No 1 7 5

Total 5 5 20 20

Administrative 13 staff Patients 15

Out of total sample size of 50. 37 respondents feel that there is need of computerization of departments in hospital for the better and efficient usage of the available resources. 16

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Table 2 Opinion about the existing Hospital Management System

Category (n=50) Managers Doctors Patients Response Good Moderate Poor 4(80%) 3(60%) 15(75%) 8(80%) 30(60%) 1(20%) 2(40%) 5(25%) 2(20%) Total 5 5 20 10

Administrative staff Total no of

respondents(%)

20(40%) 50

5 0 4 5 4 0 3 5 3 0 2 5 2 0 1 5 1 0 5 0 G ood poor Manag ers D octors Patients C lerkcial s taff Total no of res pondents

This hospital has a good Hospital Management System which is not properly/ completely in use. The study reveals that the department is providing information to the health 17

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authorities regularly. The overall opinion of the managers, doctors and patients about the existing Hospital Information System in the hospital is satisfactory (60%) and 40% feel that the system is poor. (Table-2)

Table 3 Disadvantages of the existing Hospital Management System HMS

responses regarding the existing system Strongly Agree Non-Existence Computers patient care OPD consultations take is of ward affecting 37(74%) 13 (26%) Agree Disagree Strongly disagree

Disadvantages

of

existing

Hospital Information System

longer time System break down

35 (70%) 10 (20%) 5 (10%) 10 (20%) 15 (30%) 25(50%)

The majority of the Respondents (85%) feel that the nonexistence of ward computers is a hindrances in providing the expected patient care. They also feel that the existing Hospital Management System does not help either in making the OPD consultations quicker or in generating quick laboratory reports.

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Modules of Hospital Management System (SUGGESTED FOR OHRC)

Patient Registration Appointment Scheduling Admission Discharge Transfer Bed Management Wards Management Module Patient Relations Doctors Workbench Nursing Workbench Operation Theater Electronic Medical Record Clinic Specialties Laboratory Information System Radiology Information System Pharmacy Central Sterilized Supply Department Blood Bank Housekeeping/Laundry Equipment Maintenance System (EMS) Healthcare Packages Patient Billing Insurance and Contracts Management Hospital Administration Roster Management HRMS Financial Accounting 19

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Goals of proposed system

1. Planned approach towards working: - The working in the organization will be well planned and organized. The data will be stored properly in data stores, which will help in retrieval of information as well as its storage. 2. Accuracy: - The level of accuracy in the will be higher. All operation would be done correctly and it ensures that whatever information incoming from the center is accurate. 3. Reliability: - The reliability will be high due to the above stated reasons. The reason for the increased reliability of the system is that now there would be proper storage of information. 4. No Redundancy: - the utmost care would be that no information is repeated anywhere, in storage or otherwise. This would assure economic use of storage space and consistency in the data stored. 5. Immediate retrieval of information: - The main objective is to provide for a quick and efficient retrieval of information. Any type of information would be available whenever the user requires. 6. Easy to Operate: - The system should be easy to operate and should be such that it can be developed within a short period of time and fit in the limited budget of the user.

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Hospital Management System - Registration

The Registration module is an integrated patient management system, which captures complete and relevant patient information. The system automates the patient administration functions to have better and efficient patient care process. Patient Registration Details Inpatient and Outpatient Registration Medical Alerts Details Appointment Scheduling (Patient / Doctor wise) Doctor's Schedule Summary Doctors Daily Schedule List Patient Visit History Medical Record Movements Appointments for Radiology tests and Operation Theatre Patient Visit Slip Sponsorship Details It provides for enquiries about the patient, the patient's location, admission, and appointment scheduling and discharge details. Furthermore, this system even takes care of package deals for a patient for a fixed cost. Medical Record keeps an abstract of clinical data about patients. It allows easy retrieval of medical records on patients.

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Hospital Management System - Electronic Medical Record

The EMR Module is a fully integrated knowledge repository that caters to Medical and clinical records of patients in the hospital. The system supports medical professionals of various departments of the hospital with relevant information like medical examinations, diagnoses, treatment histories, test results and so on. The module provides access to critical and complete patient data that leads to high quality cost effective and efficient patient care. The EMR should have the following features

Patient Search with Various Search Strings Patient Demographic Viewing Previous Visit Details Medical History of the Patient Billing Details of Patient

In addition the user should be able

view investigation requests, prescriptions, reports

and other clinical details. The system should provide separate access rights for each part of the EMR. The patient medical file can be securely retrieved from this module and sent across LAN and WAN and also can be E-mailed

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Hospital Management System - Billing

The Patient Billing module should handle all types of billing for long-term care. This

module facilitates cashier and billing operations for different categories of patients like Outpatient, Inpatient and Referral. It provides automatic posting of charges related to different services like bed charges, lab tests conducted, medicines issued, consultant's fee, food, beverage and telephone charges etc. This module provides for credit partly billing and can be seamlessly integrated with the Financial Accounting Module. The billing module is extensively flexible by which each of your billing plans can be configured to automatically accept or deny. The system is tuned to capture room and bed charges along with ancillary charges based on the sponsorship category. The Billing Screens is used for In-patient and Outpatient Billing and Invoicing. Further more the charges for various services rendered can be recorded through service module and this can be used for billing purposes. Payment Modes / Details Sponsorship Conditions Details Patient Billing Details Package Installment Approval from Sponsor Company Sponsorship Details Package Registration Sponsor Verification Retroactive Processing User-defined Billing cycles Automatic Room and Board charges Recurring Ancillary charge capability Auto-generated Codes and Billing Criteria Provision for Pre-billing Extensive third-party Billing

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Hospital Management System - Financial Accounting

The Financial Accounting Module should deals with Cash/Bank, Receipt/Payments, Journal Voucher and General Ledger etc. Books like Cashbook, Bankbook and Ledger book can be generated. This module should generate reports like Trail Balance, Balance Sheet and Profit and Loss statement. The Financial Accounting Screens should describe about the Account Payable, Account Receivable and General Ledger. Also describe the activities related to IP, OP, Bank related activities and provision to clearing the Supplier Invoice and keep track of the Account Receivable and Revenue related activities. The services that are covered by the sponsor companies, Insurance Agencies, Family Accounts, Individual Accounts, sponsorship details of the patient, Health Card Insurance are should be recorded in the system.

Hospital Management System - Fixed Assets

The Fixed Assets Module should deals with all the activities that are related to the Fixed Assets Part of Financial Accounting. This describes activities that are related to: Identifying an item as a Fixed Asset Allocating depreciation Managing its movement Maintenance Revaluation and Disposal etc.

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Hospital Management System - Payroll

The Payroll & Personnel module should provides a monthly analysis. The maintenance of employee bio-data, Attendance / Overtime details. It also reports on absenteeism, leave encasements etc. The Personnel & Payroll department is responsible Employee Related Activities like appointing the staff, maintaining the employee database, Fixing allowances and deductions, Leave entitlements, Leave sanctions, Loan, Termination Process, Maintenance of Hospital documents, Insurance details, Tenancy Contracts and Vehicle Registration. deal with Pay (and deduction) calculation, printing of salary slip, salary certificates, and PF statements, Gratuity Statement and

Hospital Management System - Outpatient Management

The Outpatient module should serve as an entry point to schedule an appointment with the Hospital Resident Doctor or Consultant Doctor for Medical Consultations and diagnosis. This module should support doctors to take better and timely consultation decisions by providing instant access to comprehensive patient information. Patient visits are divided into New, Follow-up and Review. The module also handles requests and results of laboratory tests and other examinations. External Doctors visit to in patients can be defined as "Call on". Some patients may avail only the hospital facilities like Lab, Radiology, Nuclear Medicine, and Physiotherapy and so on. Medical Alerts Details Consultation Duty Roster Diagnosis Details Triage Parameters Patients Appointments Daily / Weekly Schedule Summary Appointment Scheduling / Rescheduling Facility Outpatient Medical Observation Details 28

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Hospital Management System - Inpatient Management

The inpatient module should be designed to take care of all the activities and functions pertaining to Inpatient Management. This module automates the day-to-day administrative actives and provides instant access to other modules, which leads to a better patient care. It should provide comprehensive data pertaining to Admission of Patients & Ward Management. Availability of beds, Estimation, Agreement preparation, Collection of advance, planned admission, Emergency admission and so on. The Inpatient module should also deals with Ward Management Shifting from one ward to the other, Bed availability, Surgery, Administration of drugs, nursing notes, charge slip and so on. Admission Cost Estimation Admission Approval Admission Request Doctor Transfer Details Nursing Notes IP Medical Observation Pending Drug Request Surgery Scheduling Details Discharge Notification Summary Expected Date and Time of Discharge The module tracks every visit made by the patient and caters to follow-up visits of patients, along with multiple appointments.

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Hospital Management System - Pharmacy

Pharmacy module should deal with the automation of general workflow and administration management process of a pharmacy. The pharmacy module should equip with bar coding facility, which makes the delivery of medical items to the patient more efficient.

Enquiry Quotation Purchase order Online approval, Pharmacy drug configuration Pharmacy stores configuration Drug issue to patients and billing Unit dosage facility Supplier information Maintenance of drug inventory Automatic reorder level setting Purchase Requisitions Purchase Order Online request for stock from various sub-stores Online stock transfer Maintenance of stock at different sub-stores Return of items nearing expiry Destruction of expired items Physical stock verification and adjustment Goods receipt Stock Transfer (inter store stock transfer) Stock Adjustment Stock in Hand reports 30

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Hospital Management System - General Store & Inventory

General Stores and Inventory module should deal with Purchase of Items, Issue of Items, Maintenance of Stock, Automatic Reorder level Setting, Online request for stock from various sub-stores, Online stock transfer, maintenance of stock at different sub-stores, Physical stock verification and adjustment, Return of items to supplier etc.

Stock management Stock control Stock Purchase through Enquiry generation Sub stores issues and receipt of stocks External hospital stock issues and receipt Option to include and track gift or donation of stock Stock requisitions from sub-stores and corresponding management Quotations and Purchase Requisitions Purchase order generation and processing- LPO, Emergency Purchase order, Principal and Blanket PO Advance payment requisitions to Finance Goods Receipt Note and Purchase returns Automatic stock updates on receipt of goods Stock returns and destruction tracking Invoice verification Supplier management and supplier payment bucket facility available Supplier invoice management 31

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Hospital Management System - Laboratory

The Laboratory module should automate the investigation request and the process involved in delivering the results to the concerned department/doctor of the hospital. Laboratory module starts with receiving the online request from doctors and also allows laboratory personnel to generate requests. The Laboratory module should support to perform various tests under the following disciplines: Biochemistry, Cytology, Hematology, Microbiology, Serology, Neurology and Radiology. Tests are grouped under various sections and sample type (specimen). Based on the request the user can input the sample and generate the sample number. Results can be entered based on the sample type either to one test or multiple tests. If the test result requires approval, the supervisor has to approve the result and it is made available to concerned doctors. Sample Result Entry Test Report Entry Specimen Association Details Antibiotic Details Result Range for Test Investigation Request Bulk Sample Request Sample Details Samples Received from External Laboratory Samples Dispatch to External Reference Laboratory Investigation and Treatment History

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Hospital Management System - Radiology

Radiology module should cater to services such as X-ray, Scanning, Ultra sound etc. Scheduling of Radiology resources is possible. The system should store all the result details of various tests and makes a Report based on the Test Results. These Tests are carried out both for Inpatient and Outpatient. The system should store all the details (like patient number, Test Report like X-Ray, Scanning details) and for each scan the system generates a unique number for the image. Investigations can be done only after the billing is done. This rule is exempted when the case is declared as Urgent.

Hospital Management System - Physiotherapy

This module should facilitate tracking the services given to patients depending on the consultant's recommendations. Physiotherapy sessions are carried out both for Inpatient and Outpatient. Appointment has to be fixed by the patient for these sessions. All the Appointments to the Physiotherapy will be through the consultant. There will be no direct appointment.

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Hospital Management System - Dental

Dental module should cater to the services rendered by the dentists. Treatment and follow-up treatments are tracked using this module. Progress readings can be recorded through this module.

Hospital Management System - Service

The service module should deal with all the services available in the hospital and the charges for these services are stored through this module. There are various services that are available in the hospital can be seen. SERVICE MASTER: This master gives the details about package details, Group detail ROOM TYPE MASTER: This gives the details about Room Type (Ex: Private, Semiprivate, Deluxe, ICU, Suite etc) and their charges. CONSULTATION CHARGE MASTER: This gives the details about Doctor and the charges (like new visit, Follow-up, Review and Call-on). REVENUE TYPE MASTER: This gives the predetermine charges for various service given by hospital (Like Ambulance, Anesthetists Fee, Baby Cot etc).

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Hospital Management System - Help desk

The Help Desk Module should automate the day-to-day functions of the Front office management of a hospital. This module helps in assisting patient with accurate information and supports in handling patient related enquiries efficiently. Patient related enquiries Bed Allotment Admission Details Demographic Details Payment Details and Discharge Details.

Doctor related enquiries

Availability Details OP Clinic Details Appointment Schedules Operation Schedules and Charge Details

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Conclusion
THE PRESENT SCENARIO IN INDIA IS THAT MOST OF THE HOSPITALS ARE PARTIALLY COMPUTERIZED. THIS SYSTEM EXISTS IN SOME HEALTH CARE FACILITIES, WHERE ENTRIES ARE MADE BY DIFFERENT HEALTH CARE PROVIDERS, SUCH AS PHYSICIANS, NURSES AND THERAPISTS, INTO THE COMPUTER IN DIFFERENT NODES IN A LOCAL AREA NETWORK. THE SURVEY CONDUCTED IN THE HOSPITAL REVEALS THE IMPORTANCE OF INFORMATION NETWORKING BETWEEN THE DEPARTMENTS. MAJORITY OF THE BENEFICIARIES OF HOSPITAL MANAGEMENT SYSTEM, ARE AWARE ABOUT THE ADVANTAGES OF COMPUTERISATION IN THE HMS IN PROVIDING BETTER HEALTH CARE. ALL OF THEM AGREE THAT ONLY IN AN EFFICIENT SYSTEM THE INFORMATION CAN BE READILY AVAILABLE.

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