University of the Philippines - Visayas Master of Management in Business Management

Management 286 Management Information Systems

John Eric M. Abela, Ma. Luisa B. Alba, and Pia Christie F. Mejia Proposal for the use of an Enterprise Resource Plan for the patient records and accounting processes of the Medical Mission Group (MMG) Hospital and Health Services Cooperative.

Information Systems Strategic Plan For

MEDICAL MISSION GROUP (MMG) HOSPITAL AND HEALTH SERVICES COOPERATIVE

Page 1 of 22

Project Title : Information Systems Strategic Plan for Medical Mission Group (MMG) Hospital and Health Services Cooperative

Proponents : John Eric M. Abela Ma. Luisa B. Alba

Pia Christie F. Mejia

I. EXECUTIVE SUMMARY

This is a proposal for the introduction and adoption of an Enterprise Resource Plan (ERP)

for the Medical Mission Group (MMG) Hospital and Health Service Cooperative of Roxas

City in order to make its record keeping and accounting operations more efficient and cost

effective, thus allowing the company to provide quality healthcare at a lower cost to its

clients.

Proposed Changes to System Processes:

Electronic Medical Records (EMR)

Electronic Billing and Accounting System

Cloud Sharing and Backup

The initial investment for the proposed ERP is estimated to cost P350,000.00, which shall be

taken from the Special Projects Fund of MMG. If the same should prove insufficient,

available unallocated funds from the Capital Expenditures Fund shall be utilized. Subsequent

operating expenses shall come from the regular fund.

Estimated return on investment is three to five years, to be sources from revenues from

increased client base and cost reduction measures on office supplies and manpower

requirements.

Page 2 of 22

II. INTRODUCTION

The Medical Mission Group (MMG) Hospital and Health Service Cooperative of Roxas City is

a multispecialty clinic with over twenty five rooms/clinics and over thirty doctors and/or

medical specialists. It was founded as a cooperative by a group of twenty one doctors on 28

October 1997 and is engaged in bringing quality and affordable healthcare services to the

people of Roxas City and the province of Capiz. Its current members include doctors,

nurses, paramedical healthcare workers, and non-medical personnel.

Through the years, MMG has grown in terms of membership, infrastructure, and

operations. At present, it has offices in a two storey building along Washington Street by

the river bank, a stone’s throw away from the City Plaza. Housed in this building are its

laboratories, clinics, and X-ray facilities, including its own pharmacy.

With the many developments that MMG has undergone throughout the years, its day to

day operations have largely been done manually. From patient records to its billing system,

laboratory results, and even pharmacy inventory, all these have been done without the

benefit of computers. There is very minimal information technology involved in its

operations.

And despite its growth in terms of members, facilities, and patients, MMG has failed to

integrate an electronic system in its operations, thus limiting its growth in terms of patient

capability and interconnection with other franchises, among others.

The development of an enterprise resource plan for its operations would allow it to

streamline its business processes, thus allowing it to operate more efficiently, at less cost.

Page 3 of 22

III. STRENGTHS, WEAKNESSES, OPPORTUNITIES, AND THREATS (SWOT) ANALYSIS

Strengths

Simple system for record keeping and accounting, limited by its use of a manual business process.

Relatively small size

No hospital rooms

Minimal staff and personnel

Dedicated records keeping personnel

Weaknesses

Technophobic doctors and staff

Lack of IT equipment

Lack of an electronic network

Lack of personnel trained in IT

Voluminous existing manual records to be entered electronically

No existing records redundancy strategy

Opportunities

Allows for expansion of database records

Allows for sharing of data with other franchises

Increased efficiency in operations

Cost effective business processes

Financial records transparency

Visible work processes

Offsite access to patient records

Threats

Danger of confidential patient records being stolen

Corruption of data

Rejection of system by end users

Return on investment may not be realized

Page 4 of 22

IV. CURRENT IT STATUS

At present, MMG has one (1) standalone personal computer running on Microsoft

Windows XP and with basic Microsoft Office Suite installed, being utilized by two (2)

personnel, who use it exclusively for preparing office documents and simple data encoding.

While there is a broadband internet connection with a wifi router for doctors and other

personnel, there is no local area network, wireless or wired, installed which would allow

the sharing of data and other files between computers or for offsite access.

MMG has recently purchased two (2) additional personal computers for use in its

laboratory and the pharmacy, but there are presently no plans to link these with the

existing system.

There are plans of upgrading the system so as to make daily operations easier and faster,

and to have a more efficient way of record keeping, especially the patients’ medical

records. Presently, the trend for almost all healthcare facilities is to go paperless.

An Electronic Medical Record (EMR) contains the standard medical and clinical data

gathered from a patient by the health care provider. The EMR represents a medical record

within a single medical facility such as a clinic or a hospital. Electronic records are more

beneficial than paper records because it allows providers to track data over time, identify

patients due for preventive visits and screenings, monitor how patients measure up to

certain parameters, such as vaccination and blood pressure readings, and improve overall

quality of care in a practice. With a good EMR software program, it can even incorporate

laboratory results done and medications prescribed, as well the billing statements for a

Page 5 of 22

particular visit, which make for a more efficient patient records and patient data

management. Strict security measures for EMRs should be implemented, as confidential

and privileged information is involved.

Page 6 of 22

V. ISSP VISION, MISSION, AND OBJECTIVES

Vision

- To provide efficient and cost effective healthcare services to the people of the Province of Capiz.

Mission

- To effectively and efficiently use information technology as a tool in bringing down costs and streamline operations.

Objective

- To create an Enterprise Resource Plan Solution to make the operations of MMG more efficient and cost effective.

Page 7 of 22

VI. RECOMMENDATIONS

Recommendation #1: Secure the full support of the Senior Staff and Management

a. Rationale

Enterprise Resource Planning is a costly, time-consuming, and risky project. Without

the full support of upper management and the major stakeholders, i.e. doctors,

senior staff, and senior nurses, the project would most likely fail. Thus, meetings

and consultations among stakeholders must first be held to gather and address the

concerns of everyone involved and to ensure their commitment to the project.

b. Current Status and Discussion

MMG does not have an existing ERP, relying instead on manual records written on

paper and stored physically. There is a single computer whose purpose is to help

facilitate in record keeping of doctors’ appointments and correspondences, record

keeping of pharmacy stocks and sales, and printing of laboratory requests and

results; all using simple spreadsheet software (Excel) and document creation/editing

(Word). However, there is no database used, no existing network among computers

and/or workstations, no standard programs and standard business/hospital data

forms, and no robust security measures. Thus, although some of the data is encoded

electronically, there is no way of using said data for automated queries and reports.

The present method is still to print out the data from the individual

Page 8 of 22

computers/workstations and re-encode them for whatever purpose they are

needed, such as accounting auditing.

All major stakeholders who will be affected and will benefit most from the success of

the project agree that there is a need for an ERP. A budget of 5% from the over-all

cooperative hospital yearly budget has been earmarked for ERP. With such a

restriction on the budget costs, the primary goals of the ERP project are on a

modular system that would bring the most “bang-for-the-buck” with the focus on

improving patient care.

c. Steps

Set up meetings and consultations and write down actual observations within a two-

month period to get a clear picture of the needs of the day-to-day operations of the

clinic. This would enable us to define and focus on which ERP module to implement

first.

Identify the hardware and software requirements that are needed. Canvass and

secure the information needed for the suppliers of the said requirements.

Allot personnel and a budget to accomplish these preliminary steps.

d. Required Involvement

Assign at least one staff member who has the technical inclination for the tasks

involved, one senior doctor with the same inclination and secure the services of a

consultant well versed in hospital ERP.

Page 9 of 22

Recommendation #2: Create the core group who will be in charge of the ERP project.

a. Rationale

Having a small but dedicated group will make the implementation of the project

easier to handle. There would be less people to train, allowing the ERP provider to

better focus on the transfer of skills necessary for the use of the ERP. This core group

would then be the ones to train the other personnel in using the ERP.

b. Current Status and Discussion

At present, there are two (2) personnel trained in using basic Microsoft Office

programs like Microsoft Excel and Microsoft Word, however, they have no

background in database design or entries in Microsoft Access or SQL. These two,

along with a doctor and a senior staff member, will form the core group for the

project.

c. Steps

A crash course in database design and use would be necessary to familiarize the core

group with the ERP software and its modules. This will take a minimum of seven days

to complete, depending on the level of education already attained by the core group.

Once the core group has acquired a basic knowledge of the database system and the

logic behind it, an in-depth training on the system lasting between fifteen to twenty

days would be necessary to complete the training of the core group.

Page 10 of 22

d. Required Involvement

The core group shall be composed of two (2) staff members, a supervisor, and a

medical doctor. This group shall form the nucleus around which the entire ERP

project shall be initiated.

Recommendation #3: Identify, define, and limit the scope of the ERP project especially the assessment level of software customization needed, so that project costs and project duration will be manageable and doable.

a. Rationale

The project of MMG does not require a total ERP package, instead focusing on record

keeping, billing, and accounting. Keeping the level of change as minimal as possible,

yet achieving the optimum results would keep costs down in terms of money and

personnel downtime.

b. Current Status and Discussion

MMG has almost no electronic system for its operations, but it intends to streamline

its record keeping, billing, and accounting systems for easier access and

interconnectivity.

Page 11 of 22

c. Steps

The ERP system to be installed will consist of two (2) modules, an EMR module for

patient records and an accounting module to handle its accounting and billing

operations.

These two systems will be interconnected and capable of being linked and cross

referenced for easier use.

The EMR module will contain all the relevant patient data such as name, age, gender,

address, contact numbers, including his medical data such as family history, vital

signs taken during previous visits, and notes from his physician. After research on

existing EMR applications in the market, it was decided that Doctor @t Work mobile

app for Android shall be used. This application has garnered glowing reviews from

other medical practitioners and is free. It also has a desktop application synchronized

with the mobile app which can be used for primary storage in the server. Additional

security and backup by sharing data in a dedicated Dropbox cloud storage facility

shall also be utilized. This app shall be installed on the tablet PCs in the clinics, to be

used by the doctors during checkups and consultations while the desktop module

shall be installed at the laboratory, pharmacy, and records keeping PCs where

pertinent data shall be entered before and after checkups and consultations to avoid

work duplication.

The accounting module will contain all the records of tests and consultations done

on the patient, including all medicines prescribed and if the same were purchased

from the pharmacy. This module will then be linked to the server and accessed by

Page 12 of 22

the cashier for billing purposes. The Quickbooks application has modules for

accounting, billing, and record keeping, all of which can be customized to fit the

needs of MMG. There is a facility for the import of external data in the application,

which shall be used to connect it with the Doctor @t Work desktop module, so as to

facilitate the automatic sharing of data between the two applications.

d. Required Involvement

Initial roll out will require the involvement of four (4) key personnel, namely the

accounting clerk, the records clerk, the cashier, and a doctor with a background or at

least an interest in Information Technology.

These will deliver the inputs needed for the ERP provider to customize the modules

for MMG operations.

Recommendation #4: Use open source ERP solutions customized for MMG operations.

a. Rationale

The bulk of the income of MMG is reinvested in the purchase or update of medical

equipment and facilities, leaving a small slice for Information Technology

infrastructure development.

The use of open source accounting and inventory software like Quickbooks,

customized for the needs of the company, is a cheap alternative to purchasing

expensive modules from a qualified ERP vendor or securing the services of a

software provider.

Page 13 of 22

Also, having the data onsite and not in the databanks of a third party makes the data

more secure and less prone to leaks. However, to allow offsite access to pertinent

data, sharing via Dropbox shall be utilized.

b. Current Status and Discussion

At present, MMG does not have a standard ERP system in place, relying instead of

manual encoding of patient history and other data on paper, stored in filing cabinets

and other storage facilities.

Billing and purchases from the pharmacy are also done manually, requiring the entry

of data in paper ledgers and books. When a patient leaves a clinic or the pharmacy,

the doctor or the pharmacist gives the patient a handwritten note to be given to the

cashier, who will then enter the details in the cash register and collect the payment

from the patient.

c. Steps

Identify the data needed for patient records and prepare the appropriate fields in

the database for these entries. Create special attributes for the fields for blood

pressure, electrocardiograph data, and other unique data.

Determine how and when doctors enter data in the patient records, paying attention

to the manner in which data is entered to enable the end users, the doctors, to enter

data with ease.

Study the billing and accounting processes, determine how best to eliminate paper

and enable sharing across the system.

Page 14 of 22

Prepare a time and motion study among the major departments (laboratory,

pharmacy, and clinics), determining the steps involved in entering data from

laboratory results and doctors entries and prescriptions. Provide a flowchart of

systems operations and determine the optimum path to be taken. Prepare a

checklist of laboratory tests to be taken prior to the checkup and consultation with a

doctor to eliminate delays in the processing of patients.

d. Required Involvement

This phase in the ERP process requires the involvement of four (4) key personnel, the

accounting clerk, the records clerk, the cashier, and a doctor with a background or at

least an interest in Information Technology.

Recommendation #5: Data security and backup and electricity backup in case of some sort of disaster.

a. Rationale

The confidentiality and integrity of patient records is of paramount importance to

MMG, not only because of the legal ramifications in the event of unauthorized

disclosure but also in terms of the effect on the company should the trust and

confidence of its patients in MMG be lost.

b. Current Status and Discussion

Patient records are handwritten on custom printed forms and then kept in

alphabetical order in filing cabinets and other storage areas. This is an inefficient and

Page 15 of 22

insecure way of storing data, not allowing for instantaneous sharing of information

for those who need it.

c. Steps

Identify the inherent threats in the software and decide whether the system shall be

limited within the local area network or available to users online.

Even standalone systems have their vulnerabilities but threats are limited to those

who have direct actual access to connected computers. However, this will limit the

capabilities of system users and of sharing across other branches of the franchise.

If the decision is to make the data available online, cloud storage facilities like

Dropbox or Google Drive should be considered because these are cheap or even free

cloud storage. Having data available online would expand the capabilities of MMG by

giving users access even when not physically in the facility, by allowing remote

consultations of patients. However, this also exposes the data to exploits from

hackers and crackers.

Invest in an uninterruptible power supply to allow the data to be saved in case of a

power outage. A standby generator is a big investment and might not be cost

effective in the long run. The additional cost in acquiring expensive equipment will

delay the expected ROI.

d. Required Involvement

This requires the involvement of the members of the Board of Directors of MMG

because it will entail decision making at the highest level and will require significant

Page 16 of 22

costs to the company. It will also entail the involvement of the President for the

implementation of the system and the Treasurer and the disbursement of funds

necessary for the project.

Recommendation #6: Intensive technical support for the first six months of implementation

a. Rationale

Every new system has bugs in the initial phase, no system is perfect at the get go.

Technical support during the first six months will assure the company that these bugs

or flaws in the system can be fixed or remedied by the software provider before the

full implementation of the system is done.

b. Current Status and Discussion

The personnel of MMG has already mastered the filing system being used, even

though slow and cumbersome, it is a system familiar to all.

c. Steps

Ensure that the contract with the software and hardware provider(s) includes a

provision for technical support and training for key personnel for at least six (6)

months from date of implementation. Ensure also that there is a provision for

warranties.

An option for a discount on future purchases should also be requested.

Page 17 of 22

d. Required Involvement

This will entail the involvement of the legal counsel of MMG for the perusal of the

service contract and the President for the signing of the agreement.

Page 18 of 22

VII. IT FUNDING STRATEGIES

MMG has an existing capital expenditure plan integrated in its annual budget for special

projects determined by the Board of Directors. Under its charter, the company allocates

10% of its unallocated earnings from the previous year to the development of new business

processes to streamline its operations.

The funding for this project shall be taken from the budget for capital expenditures and

special projects amounting to PESOS THREE HUNDRED FIFTY THOUSAND (P350,000.00)

ONLY. The budget shall cover the following expenditures:

HARDWARE Server P40,000.00 Workstation 1 (Laboratory)* P25,000.00 Workstation 2 (Pharmacy)* P25,000.00 Workstation 3 (Records) P25,000.00 Tablet PCs (10) P120,000.00 Wifi Router P5,000.00 UPS (4) P10,000.00 External Backup Drive P7,000.00 Portable Scanner P5,000.00 Laser Printer with Scanner P14,000.00 Biometrics Scanner P3,000.00 Inkjet Printers (3) P9,000.00 SOFTWARE Microsoft Exchange Server 2012 Bundled Microsoft Windows 7 OS Bundled Dropbox Cloud Storage $750.00 per year Doctor @at work app for Android free Quickbooks free OTHER EXPENSES Labor and Professional Fees P50,000.00 * already purchased

Page 19 of 22

VIII. IMPLEMENTATION PLAN

This Information System strategy will be implemented as follows:

a. Advocacy

The existing corporate culture of resistance to change and fear of information

technology must be overcome by the commitment to the systems change by senior

management.

The advantages of an ERP and the need for the company to embrace new technology

must be made known and emphasized. Employee and staff feedback from meetings and

dialogues must be incorporated in the system and in training programs.

b. Infrastructure Building, Resource Acquisition, and Management

The existing infrastructure of the company can not handle the ERP system, thus

requiring the acquisition of new equipment consisting of a server mainframe to store all

the pertinent data, connected via wired local area network to the computer systems of

the cashier, pharmacy, and records keeper. The system shall also require the acquisition

and customization of tablet computers which shall contain the application needed for

doctors to enter data, which shall be connected wirelessly to the main server.

The main server shall be connected to a cloud storage facility, requiring the use of a high

speed internet connection from one of the major ISPs.

Page 20 of 22

The company shall also require the hiring of a dedicated information technology

specialist to install, repair, and maintain the system, to be trained by the software and

hardware provider.

c. Systems Development and Maintenance

Systems development for the first six (6) months of the system shall be done by the

software and hardware supplier, taking into account feedback from the end users of the

system. The system shall be debugged and refined over the service warranty period,

with emphasis on its ease of use by the end users and access to the data by those who

need it during the truncated life cycle of the system.

During this time, an IT specialist shall be trained in the system, who shall then take over

the maintenance of the system after the end of the service warranty period.

d. Risk Management

Risks to the system such as security breaches and loss of data should be analyzed and

the appropriate preventive measures taken. Anti virus programs, firewalls, data

encryption, and layered access should be installed and implemented to prevent data

loss.

An uninterruptible power supply (UPS) should be standard for PCs while a backup

generator, although not essential, might prove useful in case of disasters where power

outages become common.

Page 21 of 22

e. Monitoring and Evaluation

During the first six (6) months after the implementation of the system, the software and

hardware provider, with the assistance of the IT specialist, shall monitor the system for

ease of use and security, making adjustments in the GUI as and when needed, or

altering the database for easier access to the database with the minimum use of

electronic resources. Continuous and intensive evaluation by end users should be

conducted in order to allow the software provider to customize the system to suit the

needs of the company.

At the end of the service warranty, periodic evaluation should be made by the software

provider to determine the changing needs of the company and to prepare for the

installation of a new updated system.