The Hospital Operations and Management Information System is a computer-based system or software developed by the Department of Health, through the National Center for Health Facilities Development and Information Management Service. The primary objective of HOMIS is to support the hospital management for effective and quality health care by providing timely, relevant and reliable information. It is developed to systematically collect, process, store, present and share information in support of hospital functions. The development and implementation of HOMIS is a defined information systems development strategy under Hospital System Reforms of the DOH. HOMIS consists of three (3) modules, namely: Patient Management, Services Provision and Administration Modules. Module 1 or Patient Management Module supports the outpatient and emergency room consultations, admission, discharge, billing, payment (Cashier System), medical records, Philippine Health Insurance Corporation claims processing, medical social services and referral system requirements. Module 2 or Services Provision Module ensures the efficient provision of clinical services to the patient throughout the hospital stay, i.e. Nursing Care or Ward, Pharmacy, Laboratory, Radiology, Dietary, Central Stock Room and other ancillary services. Module 3 or Administration Module is the management support and includes Budgeting, Obligations Accounting, Procurement Management, Human Resources Management, Materials Management, Fixed Assets Management, General Ledger, Accounts Payable, and other financial and administrative systems. HOMIS has been installed and implemented in forty-two (42) government hospitals and most of these hospitals are using Module 1 systems. Government hospitals have difficulty in implementing Module 2 and 3 systems because of insufficient budget to acquire the necessary computers. The development of the Financial
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The Hospital Operations and Management Information System is a computer-based system or software developed by the Department of Health, through the National Center for Health Facilities Development and Information Management Service. The primary objective of HOMIS is to support the hospital management for effective and quality health care by providing timely, relevant and reliable information. It is developed to systematically collect, process, store, present and share information in support of hospital functions. The development and implementation of HOMIS is a defined information systems development strategy under Hospital System Reforms of the DOH.
HOMIS consists of three (3) modules, namely: Patient Management, Services Provision and Administration Modules. Module 1 or Patient Management Module supports the outpatient and emergency room consultations, admission, discharge, billing, payment (Cashier System), medical records, Philippine Health Insurance Corporation claims processing, medical social services and referral system requirements. Module 2 or Services Provision Module ensures the efficient provision of clinical services to the patient throughout the hospital stay, i.e. Nursing Care or Ward, Pharmacy, Laboratory, Radiology, Dietary, Central Stock Room and other ancillary services. Module 3 or Administration Module is the management support and includes Budgeting, Obligations Accounting, Procurement Management, Human Resources Management, Materials Management, Fixed Assets Management, General Ledger, Accounts Payable, and other financial and administrative systems. HOMIS has been installed and implemented in forty-two (42) government hospitals and most of these hospitals are using Module 1 systems.
Government hospitals have difficulty in implementing Module 2 and 3 systems because of insufficient budget to acquire the necessary computers. The development of the Financial Management System was not incorporated in Module 3 of HOMIS as planned because the Commission on Audit developed the Electronic New Government Accounting System to be implemented in all government offices/agencies including hospitals. The use of the ENGAS ensures correctness, reliability, completeness and timeliness in recording government financial transactions and generates financial reports in accordance with the manual policies and procedures of the New Government Accounting System. The implementation of ENGAS in the DOH Central Office does not include yet the Budgeting and Cashiering Systems. The Logistics Management Information System software developed by the DOH facilitates price monitoring of products (drugs and supplies), preparation of the annual procurement plan, agency procurement request to the Department of Budget and Management, requisition/purchase issuance, and delivery. The LMIS is presently being enhanced to align its functionalities with the current workflow processes, procurement policies of Republic Act 9184 – Procurement Reform Act and procedures, make operational the remaining systems to link
processes from procurement planning to distribution and improve management reporting capabilities. The Pharma-50 System is a simple stock card data entry system that can generate the required reports for the Pharma-50 program of the DOH. There are other computer-based systems developed by the DOH that can be used by government hospitals like the Personnel Information System and Payroll System. The PIS records the personal information, work history, leave, education, examination, training of employees and provides reports on personnel profile in support of management planning and decision making. The Payroll System facilitates and simplifies the monthly preparation of general payroll and related reports. The Unified Management Information System – Phase 1 Project is a work package to develop the generation of statistical reports from the HOMIS to the DOH Central database via FTP/Uploading process, web-enabled hospital statistical reporting system, document integration, HOMIS website, integration of the three existing computer-based systems developed by the DOH (HOMIS, LMIS and Pharma-50), and formulation of standard policies and guidelines for Security and Confidentiality, System troubleshooting, Implementation Guidelines, Software Configuration Management, Designation of HOMIS Administrator and Roles, duties and Responsibilities, System Monitoring and Evaluation, System Reporting and Feedback System. The subject of this documentis a Technical Design which includes specifications, concepts, diagrams, analyses and schematics to communicate the technical and operational requirements of the UMIS-1. It consists of the following sections:
Design Overview. Logic Diagram describing the order that logic
decisions are made for each function. System Architecture Diagram illustrating the way
the system hardware and software must be configured.
INTRODUCTIONHospital Information System (HIS)variously also calledclinical information system(CIS) is acomprehensive, integrated information system designed to manage the administrative,financial and clinical aspects of a hospital. This encompasses paper-based informationprocessing as well as data processing machines.It can be composed of one or a few software components with specialty-specific extensions aswell as of a large variety of sub-systems in medical specialties (e.g. Laboratory InformationSystem, Radiology Information System).BACKGROUNDThe implementation of Clinical Information Systems (CIS) is key to the production of qualitycare, adequate management of rare resources and productivity. A recent study has revealed anobjective correlation between the degree of adoption of technologies in healthcare andreduction of complications and mortality in hospitals. This is clear evidence that a real return oninvestment for these systems is possible. Healthcare IT is a necessity that is imposed on all thecountries of the North and South alike. However, a critical question arises and is yet to beanswered. Namely, given the differences in financial, technological, and human resources,should developing countries consider a different strategy to achieve implementation andadoption of healthcare IT? The implementation of information systems can succeed if two mainconditions are met, and these both come with a financial burden:(1) A rigorous and consistent organization of the actors and processes of care in which they areinvolved. Without this organizational approach any attempt to computerization is likely to fail.(2) A clear choice for the establishment of infrastructure (hardware and software) which alwaysrequires substantial financial investment.Although costly in human, organizational, and structural resources, the first condition appearsto be available to everyone as long as the hospital management is informed, tenacious,thorough and methodical. The concept of process is not always clearly identified (probably evenless in the South than in the North) and the complexity of care processes when combined withinadequate management of these processes is a source of non-quality, and of costly andavoidable medical errors. Within a hospital, implementation of a CIS is based on thecomputerization of care processes as well as of support processes (administrative, accounting,logistics, etc.) to ensure coherence, feasibility and effectiveness of the clinical and businessactivities of the institution.To meet the second condition, the method adopted in the North is mostly based on thepurchase of software available in the marketplace. Most hospital entities no longer developtheir own solutions in-house. This response is problematic for developing countries at twolevels. First, they do not have the financial resources to acquire a commercial CIS. Second, theydo not have the same culture and organization that are implicitly or explicitly imposed and implemented as part of the commercial solutions coming from the developed countries and forwhich these applications have been developed and tested.Several studies have examined
the North-South transfer of information systems, including animportant one by Richard Heeks . He concluded that the information systems that succeed arethose that best incorporate the key technical, social, and organizational environment aspects inwhich they are implemented. Heeks also noted that the failures are mainly due to a North-South transfer of information that does not take into account the context, or the local attitudestowards modernization and rationalism.Therefore, developing countries face an important risk of being excluded from the pathtowards the computerization of healthcare facilities or systems, even as these are morenecessary than ever to better manage the quality of care and the limited resources available todeveloping countries.If commercial software packages seem out of reach for many poor countries, the fundamentalprinciples behind the emergence of Open Source software and the acquisition cost of software,often free of charge, is a great opportunity for developing countries. Moreover, as stressed byDidier Lamouche , the interest of Open Source is also in its ability to allow firms and nations topossess and better manage their information systems.Our article aims to analyze this particular situation while taking into account the emergence of Open Source software, and to propose a suitable and accessible development strategy that canbe mastered by the South. Today, to the best of our knowledge, no country in French speakingAfrica does possess a computerized information system that is adapted to the challenges of healthcare. In contrast developing countries of Latin America or other countries in Asia havemade significant progress toward the computerization of healthcare processes in part throughthe use of Open Source software .We will try to understand the opportunity of the Open Source movement in healthcare Inparticular; we report our experience with the use of Mediboard Open Source HIS at theHospital Mère-Enfant le "luxembourg" in Mali.We focus our remarks on hospital information systems that represent a clear and pressing needfor developing countries, even if other applications, such as systems to aid in decision-making,to support HIV/AIDS, public health reporting, or clinical research are not of lesser importance.For example, the use of technologies such as portable PDAs in epidemiological surveillance is aninteresting opportunity worthy of study as demonstrated by Yu P and all.
Service History & Order History: Users can retrieve a list of patient's previous visits with the corresponding date-time and statusand a list of patient's previous orders with the corresponding date-time, status and dosage. The rationale of "Open Source" softwareMainly based on the sharing of source code and the collaborative development by the usersthemselves, Open Source software in the developed and developing countries has seen a steepincrease over the last ten years. An example of this development is Linux which has now asignificant market share of Operating Systems (Linux in 1997 accounted for 1% of the servermarket against 30% in 2007). Concerns about lack of standardization and security in OpenSource software have been expressed for a long time and have limited their use in productionsystems. These concerns are now disappearing, as demonstrated by several studies. It is likelythat Open Source is reaching its maturity phase. Several nations have already mandated the useof Open Source in government agencies, as for instance in Brazil and South
Africa. A recent billhas passed in the US senate aiming at the same (Jay Rockfeller - April 23, 2009).HOSPITAL INFORMATION SYSTEM DESCRIPTIONHospital OS Software Hospital OS is a Hospital Information System for managing hospital operations. It is a Client -Server software in which the server works as a central unit that stores all of the informationand the clients are the units that feed the information into the server.Hospital OS Server uses the Linux operating system and PostgreSQL as the database. Both Linuxand PostgreSQL are open source programs available for download on the Internet. The Clientsoftware is developed by using Java and it can be used with Windows 98, ME, 2000, XP, Linuxand other operating systems that have the Java Virtual Machine installed.FEATURES OF HOSPITAL INFORMATION SYSTEM:1. User Interface2. Workflow Management3. Registration4. Screening5. Diagnosis6. Ordering7. Appointment8. Service History and OrderHistory9. Pharmacy10. Billing11. Lab12. X-ray User interfaceMenu Bar:each user may see different sets of menus depending on theirauthorization.Patient Status Pane:This area contains the patient's basic information e.g. HN(hospital patient number), VN/AN (visit number / in-patient admission number),name, age, insurance scheme, etc. Users can see the patient's current status(e.g. current service point, previous service point, etc.) and take
further actione.g. transfer patient record to the next service point, unlock the record (readonly), etc.Patient Transaction Tabs:Users enter the transaction details into correspondingtabs i.e. Personal Data, Visit Data, Symptoms, Orders, Diagnosis, Cashier, Lab, X-ray.Task Status Bar:Task Status Bar indicates whether the transaction completessuccessfully or not. An error message will be displayed if the transaction fails. Workflow Management: Queue: The 'Queue' Tab displays a list of the patients waiting at a service point which isdefaulted to the user's service point. Users are also able to display a queue of another servicepoint and select to work with another patient record. When a patient record is selected, thelock indicator will be changed from green to red, which will allow other users to have a 'readonly' access.The queue indicator differentiates the clinic each patient is heading towards, while thesequence number not only determines the sequence of patient arrivals, but also can be used asa counter for the number of patients currently in queue at each service point.
Patient Transfer:After patients complete their transactions at the current service point,they will be transferred to the next service point where their names will appear in thedestination's queue.Patient Query:Users can search for a patient record by either entering the HN orsearching for the patient's name (by entering the complete or partial part of the name)or ID. The system will display a list of patients with similar names.
Registration:Personal information:The system provides tools to make it more convenient to enterpersonal information e.g. calculating patient's age from the birth date, validating thenational ID number, identifying the
default address of the contact person from thepatient's address, matching gender with the title (e.g. Mr., Miss, Count, Countess, etc.).Insurance Scheme:Users can identify which insurance schemes the patient has and theone(s) to use for the current visit from a list of available schemes. The sequence of theinsurance scheme identifies the priority. In the case of an existing patient, the systemwill use the sequence from the previous visit as a default. Registration:Personal information:The system provides tools to make it more convenient to enterpersonal information e.g. calculating patient's age from the birth date, validating thenational ID number, identifying the default address of the contact person from thepatient's address, matching gender with the title (e.g. Mr., Miss, Count, Countess, etc.).Insurance Scheme:Users can identify which insurance schemes the patient has and theone(s) to use for the current visit from a list of available schemes. The sequence of theinsurance scheme identifies the priority. In the case of an existing patient, the systemwill use the sequence from the previous visit as a default.
Patient Referral:For either refer-in or refer-out patients, the patient's referralinformation and results are recorded in the screen below.
Screening:For each visit, a screening nurse is able to record vital sign information as many times asneeded. The nurse can enter primary and current symptoms from a list of keywordsprovided and enter the patient's drug allergy information. A 'Drug Allergy' label will bedisplayed in the patient's information pane on the top of the screen.
Diagnosis: Diagnosis:After the patient is investigated, the doctor's diagnosis can be entered in theDiagnosis Tab. A list of diagnosis keywords is provided. The doctor's diagnosis will bedisplayed at the patient's information pane.
Order History:The 'Order History' button allows users to see the list of previous orders of thepatient according to the selected type of treatment (lab, medicines, etc.) and time period. Incase of lab/x-ray orders, users can select an order to display its results.Users can review all lab results of the current visit on the same page.
Ordering:After diagnosing a patient, users can prescribe drugs and order lab tests, x-rays, etc. throughthe Ordering tab as follows:
Order Search:Order Search Pane provides a list of order items according to the specifiedkeyword and order category. A 'Set Order' button displays predefined groups of specific ordersfor common symptoms, for example, a 'Cold Set' may contains 20 tablets of paracetamol, 1bottle of cough syrup, and 20 tablets of nasal decongestion. The 'Re-Med' button displaysprevious orders of the patient from any selected previous visit.Order Details:Order Details Pane specifies a dosage, duration, and special instructions of eachorder. The 'Special Instruction' checkbox allows users to enter free text in case of a specialinstruction e.g. 1 tablet in the morning and 2 tablets at bed time.Order Summary:Order Summary Pane displays all items ordered for this patient in the currentvisit according to the selected order category and period.
User interfaceMenu Bar:each user may see different sets of menus depending on theirauthorization.Patient Status Pane:This area contains the patient's basic information e.g. HN(hospital patient number), VN/AN (visit number / in-patient admission number),name, age, insurance scheme, etc. Users can see the patient's current status(e.g. current service point, previous service point, etc.) and take further actione.g. transfer patient record to the next service point, unlock the record (readonly), etc.Patient Transaction Tabs:Users enter the transaction details into correspondingtabs i.e. Personal Data, Visit Data, Symptoms, Orders, Diagnosis, Cashier, Lab, X-ray.Task Status Bar:Task Status Bar indicates whether the transaction completessuccessfully or not. An error message will be displayed if the transaction fails.
Pharmacy:
Preparing & Dispensing:After orders are confirmed, pharmacists can select a patient from thepharmacy's queue to prepare the order, print labels and dispense orders in the 'Order' Tab.
Drug Return:The system allows users to return drugs which were already dispensed in thereturn window.
Billing: Calculate Expenses:Patient's expenses can be calculated and summarized by insurance schemefor users to review before the invoice is issued. The expenses which were assigned to eachinsurance scheme can be reassigned and recalculated as appropriate.Invoice:Note that the expense calculation is for user review only; the calculation results willnot be recorded until users click 'Save', which will also generate an invoice and display it on aBilling Tab.Payment:All invoices of the patient in the current visit will be displayed in the 'Invoice' Pane.The 'Generate Receipt' button will calculate all expenses from these invoices and generate areceipt, while the 'Pay' button will display all expenses by billing group, where users can recordthe transaction and print the receipt.
Lab:On the 'Lab' tab, a list of lab orders will be displayed along with its status and 'Refer Out'indicator. Each order's indicator will be defaulted as 'X', which means a refer-out is notrequired. For refer-out orders, users can change the indicator to '?' by selecting the orders andchoosing 'Refer Out' button.Users can also add new orders, enter and submit the lab results. In case some lab results arenot ready, users can suspend the results by choosing 'Suspend'.
X-ray: An 'X-ray' tab displays a list of x-ray orders to be processed and a list of completed x-ray ordersseparately. Users can enter related details for each order e.g. the quantity of x-ray films used,the x-ray position, etc.
