Slide 1MH-204: HMIS

CHAPTER III – HOSPITAL INFORMATION SYSTEMS

Slide 2MH-204: HMIS

Today Tomorrow

Location Hospital Decentralized, at home

Time Symptomatic, curative Preventive, lifetime

Focus On the process and provider On the patient

Scope Cure Patients Care for Citizens

Methods Invasive Less invasive

Healthcare is changing…

Slide 3MH-204: HMIS

Order Process Manual Automated

Experience Individual Best Practices

The Process Fragmented, isolated disease mgt.

Clinical Decisions Personal preferences Guide lines / evidence based

Processes are changing …

Information Fragmented, isolated Consolidated / complete

Today Tomorrow

Slide 4MH-204: HMIS

Data completeness

Fragmented Consolidated

Data integrity Manual/error prone Systematic mgt. and control

Data access Limited, Difficult Any time, any place

Technology Isolated systems Integrated systems

IT is changing …

Data availability Slow Real time

Today Tomorrow

Slide 5MH-204: HMIS

The Hospital

Medical Knowledge

High Quality

Cost Effective

needsActivities InformationAssessmentneeds

produces

Slide 6MH-204: HMIS

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

Slide 7MH-204: HMIS

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

Slide 8MH-204: HMIS

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

Slide 9MH-204: HMIS

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

�...

Slide 10MH-204: HMIS

HIS

� “an integrated effort to collect, process, report and use health information and knowledge to influence policy-making, programmeaction 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.

Slide 11MH-204: HMIS

HOSPITAL INFORMATION SYSTEM

Registration Consulting Ward Nursing

Pharmacy

Stores & Purchase

RadiologyLaboratoryOT Blood Bank

Diet & Kitchen

And more...

Slide 12MH-204: HMIS

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

Slide 13MH-204: HMIS

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 innovationthrough research;

� improving governance, mobilising new resources, and ensuring accountability in the way they are used.

Slide 14MH-204: HMIS

14

HIS in health services planning

How will we know when

we get there?

♦ Monitoring and evaluation

♦ Choice of appropriate

indicators

Where are we now?

♦ Identification of needs and

problems

How will we get there?

♦ Development of

interventions

♦ Identification of resources

Where do we want to go?

♦ Setting priorities and targets

Pervasive role

of information

Slide 15MH-204: HMIS

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.

Slide 16MH-204: HMIS

Domains of health data

• health determinants

• health system inputs

• health system outputs

• health system outcomes

• health status.

Slide 17MH-204: HMIS

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

Slide 18MH-204: HMIS

Typology of measurement domains in health care

Health determinants

Risk factorsBehaviours

GeneticsEnvironment

Socio-economic &

demographic

Health system inputs

Policy

FinancingHuman

resourcesOrganization

Health system outputs

Information

Service availability and

quality

Health system outcomes

Service utilization

Health status

Mortality

Morbidity / disability

Well-being

Figure 2 Typology of measurement domains

Slide 19MH-204: HMIS

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

Slide 20MH-204: HMIS

This information can be categorized as

Slide 21MH-204: HMIS

Slide 22MH-204: HMIS

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

Types Of Hospital Information System

Slide 23MH-204: HMIS

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.

Slide 24MH-204: HMIS

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.

Slide 25MH-204: HMIS

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.)

Slide 26MH-204: HMIS

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.

Slide 27MH-204: HMIS

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.

Slide 28MH-204: HMIS

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).

Slide 29MH-204: HMIS

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.

Slide 30MH-204: HMIS

Classifying performance indicators and healthcare process development

Slide 31MH-204: HMIS

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.

Slide 32MH-204: HMIS

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.

Slide 33MH-204: HMIS

Other examples

Slide 34MH-204: HMIS

Other examples