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Hospital Automation The Full-System


Dr. Ahmed Ayed

It can 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 upgradeable. 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 utilization of facilities.

Enterprise profile; background:
AL AGOUZA MEDICAL CENTER is a newly constructed governmental primary care center, situated in the heart of Al Agouza district in Giza governorate. It's only constructed 3 years ago to meet the needs for health care services at this region at affordable costs, with the kind of improved modern and advanced services the Ministry of Health is striving to achieve. The center presents only outpatient clinics services from 9 am to 2 pm daily, except for Fridays, and emergency services everyday from 8 am to 5 pm. The specialties that are found in the center are pediatrics, internal medicine, gynecology and dentistry. There is no inpatient department and no operating rooms as this center is a primary care center only.

The center has its own pharmacy that gives medications that were prescribed to the patients by the center's physicians and dentists for free. There is also a laboratory in the center. This laboratory presents a group of advanced hematology and parasitology investigations for the people at affordable costs. An ultra-sonic unit is present too in the center, serves mainly the pregnant women during their pregnancy months. The center is composed of two floors only. The ground floor is made up primarily of the reception area, the administrative affairs department, the laboratory, the pharmacy and the emergency department, the second floor is made up of the outpatient clinics, the dentistry department, the sonar room, and in between there is a waiting area for the patients. The manager room is found at the second floor too.

Current Operational System:

Technology is a vital aspect to any medical facility and one which always rapidly and quickly changing especially in the medical field and AL AGOUZA MEDICAL CENTER is no exception, but thanks to fact that it's still new, all the available equipments are correspondingly new and up-to-date. But these equipments are the medical equipments only; the operational system here in the center is only manual system. When a patient visits the center, he goes through diagnosis of a specialist doctor. If further investigation is required, the doctor sends the patient for a laboratory test. The patient, after being tested at the laboratory, has to wait for a couple of hours/days till the reports to be released. Once the reports are released, the patient has to collect the report and hand it over to the specialist doctor, who examines the reports and determines the criticality of the patients health condition and treats with necessary therapy. The patient maintains a case file/folder which contains the details of the patients medical condition like the laboratory reports, drugs prescribed from time to time, and other remarks by the concerned doctors about his/her day to day health. Currently, Information System is not employed in the center as all the records are maintained on paper. The patients case file, which is merely a folder with all the details of health condition on paper, laboratory test reports, drug prescriptions are all paper based which are all carried by the patient himself. The center does not maintain any such records, thus making it very tedious for the patient to carry each and every document on his center visit.

The administrative affairs department and all HR operations are done in paperwork, and that, for sure, will cost a lot of time for writing, organizing, arranging, preparing and filing. Filing in special, takes not only time, but also space and costs. For example, a piece of instruction should be written in paper, signed by the director of the department, then copied and distributed to all employees by hand. The reservations of outpatient clinics appointments are done by hand at the reception. The laboratory investigations bookings are done too by hand. The employees of the finance department, which constitutes a part of the administrative affairs department, do all their transactions in paperwork, and as expected, these transactions are submitted to the human faults. In the medical affairs department, the physicians, themselves, examine the patients; complete their files in paper with the aid of the nurses, the physicians fill in the medical missing information of the files, and the nurses fill in the personal aspects. The physicians order for the investigations they want in paper too. The laboratory investigations results are written in paper and are given to the patient by hand; these results together with the patient data are registered in files at the laboratory by hand too. All the pharmacy work is done too by hand and in paper work, medications in and out, and the inventories are all registered in paper files.

Problems with the current system:

Incomplete automation, or better say the NO automation, which is found in the center itself is a big problem that faces the strategic management of the center, and constitutes a huge obstacle in front of any improvement and development hoped. The deficiencies of the current system are as follows: A very slow and cumbersome system that takes a lot of time and effort to complete the operation, any operation with no time saving at all. A very costly system that spends a lot of money on paperwork. Time of the physicians and the employees are spent totally and misused while using the current system; this will make them lose the opportunity of good use of that time in ongoing improvement and research. Time of patients too is precious for them; they will prefer to go a fast-moving hospital rather than this center. This system is impractical among the nowadays highly technological communities, giving the chance for competitors to exceed and prevail.

"A patient is a person and not a statistic. It is our job to satisfy him" Dr. William E. Lowers Credo Founder, Cleveland Clinic, USA, 1921
Al-Agouza Medical Center is a promising center which devotes considerable emphasis on patient Care. It plans to implement complete automation of all its departments. The short term objectives of the on-line computerized system in the center 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.

SWOT analysis
Strength: It will help the medical professional in making quick and effective decision by analyzing patient history particularly when the patient is in critical condition.

It will minimize the paper work for administrative department. It will help to collaborate and share knowledge between health professionals. It will also improve the standard of inter department function. Errors in treatment and medication will be reduced to a large extent. Weakness: Complex structure of developing the IS. Huge database to be developed and maintained. Training the different users of IS. Cost and time involved in developing the IS. Opportunity: Unwanted occupancy rate is reduced. Effective Patient relationship management will increase the occupancy. Threats: Ethical and legal implications involved, if the security of the data fails.

Formulating justification to convince the top management with reference to

general benefits of IT, present situation, problems and requirements of the hospital, expected benefits, costs and time line of costs and benefits. Preparing the center first by implementing the ten steps of infrastructure; 1We make and take decisions. 2We manage information. 3We need IT tools; (Hardware, Software, Communication lines and Networks). The first 3 steps constitute Phase I (orientation). It will start by convincing every employee that he could make and take decision in general, about everyday work and about future plans and taking the responsibility of this decision and clarifying the difference between making and taking decisions, and the steps of making decisions (Identifying a problem, decision criteria etc.) and everyone in an organization makes decisions, and that not always decisions are time consuming. This step can be enhanced

by revising the center mission and vision. Orientation, too, is about ''change'', putting in mind that nearly all mankind has constraints about change. 4Flat organization. 5Automation. 6Flow of Information. The second 3 steps constitute Phase II. It starts by flattening the organization, that's decreasing leveling stages of managerial system, to work as a flat organization. The manager will serve as a coach for all departments, supporting them, aiding them finishing their work and removing any obstacle. Each department works as one unit, with its own coach, members putting their heart in completing work, and the department goals are by their eyes. 7Empowerment. This is Phase III. 8Defining Objective. This is Phase IV. 9Results. This is phase V.
10- Personnel and this is phase VI, and the last phase.

Identifying the general requirements of the center; The need to automate the administrative department (ADMINISTRATIVE INFORMATION SYSTEM) The need to automate the medical department (CLINICAL INFORMATION SYSTEM) The need to automate the pharmacy (PHARMACY INFORMATION SYSTEM) The need to automate the laboratory (LABORATORY INFORMATION SYSTEMS)

Write and deploy a request for proposal (RFP) to the IT vendors. The RFP addresses the centers profile, objectives, problems and requirements, current, required system and functionality, delivery lead time, installation place, warranty, maintenance, training and acceptance criteria.
Evaluate the proposals of the selected IT vendors; evaluate their previous

accomplishments and their background.

Evaluate the Demos (Easiness, Integration, Features > Requirements,

Modularity, Flexibility , Documentation, Training , Language, Platform, Customization, Speed, Maintenance, Compatibility & Cost ) Select the optimum vendor.
Formulate standards and procedures for monitoring. Standard Operating

Procedures (SOPs) within the context of HIS, is a written description of steps for all significant activities relating to the practice of management of HIS that has been approved by a program/ persons in charge of an HIS. SOPs should accurately reflect good information management practices, be sufficiently practical and be usable in the HIS. The good HIS management practices relate to general aspects of HIS management functions including data collection, compilation, analysis, storage, data processing, record storage, handling of urgent data requests/ needs, management of the devices/ tools/ appliances used to manage the data .

Construction Phase: is a multi-phasic process in which the manager is fully

involved. The manager must also be involved in motivating the timely progress of the project since motivation declines as we go forth. Construction involves several phases, each of which must be evaluated at its conclusion and approved with signatures before proceeding to the next. A flowchart was developed highlighting the various departments and their modules, revolving around the patient information database (PID), and communicating with each other. Operations and specifications of the system are documented.

Implementing and testing:

a. General guidelines: start by a prototype; observe the benefits of subdivision

and the cost of failure.

b. Hardware Acquisition (purchase the hardware, preferably through the same

vendor as a turnkey solution. Check that it meets the agreed upon specifications, warranty, and manuals are provided. This involves the server, client PCs, network, accessories, printers, bar code readers etc.

c. Installation of a local area network in the Centers building. The LAN will

connect all departments and divisions to the health information portal. The WAN will connect the center with the national authorities.

d. Software Acquisition (check you have all modules and third party software,

check speed, integration, communication, generated output reports, periodic upgrades/ manuals) e. Training:

Give a general orientation about the HMIS to the top management.

Training is an ongoing process whether for new applications or for new employees. Conduct training needs assessment of HMIS and program staff at all levels.

Develop criteria to identify suitable personnel for training as HMIS facilitators.

Prepare a plan of training of HMIS facilitators at the tactical level.

Specific training: for operational management, to be the first line, on site troubleshooters. Check that the vendor has trained on-site trainers from among selected centers staff.

f. System testing: # Interoperability: The hardware, software, LAN, and telecommunication system used by HMIS and sourcespecific databases will be userfriendly. Impediments to interoperability, involving language, interface, or data structure, will be taken into account at the outset. HMIS users will be able to access required information in the predefined required format through simple menudriven procedures. # Check that the system objectives are met. Output reports are the only measureable criterion for the objectives. It should be exactly as requested, and the information displayed should be as entered in the input forms. # Input forms procedures: Check that the center staff is aware of the proper methods for data entry. Check that data input is not compounded by crashes, errors or changes in the information fed. # Error and correction procedures: Check that your staff (especially front line managers) is aware of the measures to be taken upon encountering regular system errors. I.e. restart if system hangs. # Check that the systems running cost is within the expected.

# Check that user and troubleshooting guides are available; complete system documentation (procedures manual, computer programs, and machine operation manuals). # Check that you have a working backup copy from which to restore the software in case of system collapse. # Check that the number of users and the capacity of the system are as agreed upon. # Check that the system speed in generating reports is as agreed upon. # periodically check for possibly required or available upgrades and discuss those with the vendor. Upgrades include modules, new versions of the software, more clients, more program record capacity, etc. Upgrades should be tackled in advance to the time they are required at to anticipate for delivery delays. Implementation set off: the system is handed over to the hospital staff, yet monitored by the IT vendor for a while.
g. h.

Data conversion; converting manual files to electronic files. It should be limited to the bare minimum data required for efficient operation of the system.

System maintenance: System maintenance can be: Scheduled: contract based maintenance service, whether on site or remote, that is provided for a known period of time that is extendable as per the centers requirements. Unanticipated: The vendor should be able to provide immediate support upon unexpected events.

Changes: change request.

Backups are an important aspect of system maintenance. They should be performed on daily basis and the backups stored in a remote area. This can be media based or internet based, the latter however is more costly.

System Evaluation (by user teams, the internal IT department or even an external auditor)

Objectives achievement: evaluated by the output report. Evaluates speed, integration, communication etc grades (fully achieved, mainly achieved, partly Achieved etc)

System Cost.

Benefits evaluation; check that you are getting the due benefits which you should start harvesting by the third year from implementation and should be rising so forth, including quantifiable benefits such as higher financial gain, and non-quantifiable benefits such as better work flow and patient satisfaction. Benefits should exceed cost. Security and control; check that the system complies with the level of security you originally desired and preset with the vendor including the per person authentication, firewalls, antivirus and anti hacking protection. Future needs. We should define the anticipated future needs and expansion possibilities and make sure the system will be able to cope with them before they are due.

Meeting the pre-designed key success criteria put by the designer and manager.

Evaluating the design techniques (A system may meet the key success criteria and yet not be technically a good system): i. Design efficiency: check the relationship of various modules, data Flow and output reports
ii. Operating efficiency: check simplicity, user friendliness, accuracy,

speed, report design, down times, fast recovery from crashes etc.
iii. Maintenance efficiency: logs, backups, remote repair etc.

System Efficiency Audit: a third party external auditor can check the efficiency and evaluate the system. Efficiency audit will seek to answer the following questions on annual or semi-annual basis: -Is the system being used in the right way? -For the right reasons? -Is it cost effective? -Is the system secure? -Is the system in concert with the organizations strategy? -Does the organization have the computer knowledge and skills it requires to run the system?

In ten years time, after implication of the HIS in the center, proper usage, periodic evaluation and updating, this center will be one of the brilliant centers allover Egypt. It will gain patients confidence and satisfaction and its profits will be increasing obviously.

Special Thanks

First of all I would like to thank Dr. Mohsen El Shamaa

for his kind and vigilant support, for his valuable input and advice, his cooperation, and most of all patience. Dr. Mohsen, I hope I will always have the honor of attending your lectures.

I would like to especially express my gratitude to the staff of the

management center at the AUC. They provided us with the means to gather all the information and were more than ready to spare us the time and effort. I would like to show the utmost appreciation to each of Ms. Eman Srour and Ms. Dalia El Dabbagh.

I would also like to thank all my colleagues for the time I spent with them.

T hank You