HOSPITAL INFORMATION SYSTEM IN MEDICARE - AN EXPERIENCE AT TATA MAIN HOSPITAL, JAMSHEDPUR

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1 HOSPITAL INFORMATION SYSTEM IN MEDICARE - AN EXPERIENCE AT TATA MAIN HOSPITAL, JAMSHEDPUR Mohanty Rajesh*, Rana Sarosh D**, Kolay Saroj K*** ABSTRACT Hospitals are the key institutions in providing relief against sickness and disease. They have become an integral part of the comprehensive health services in India, both curative and preventive. Significant progress has been made in improving their efficiency and operations. Effectiveness of a health institution - hospitals or nursing homes, depends on its goals and objectives, its strategic location, soundness of its operations, and efficiency of its management systems. The administrator's effectiveness depends upon the efficiency with which he is able to achieve the goals and objectives. Some of the major factors determining the effectiveness of a health institution includes patient care management and patient satisfaction. Hospitals are very expensive to build and to operate. Administrators and professionals have to be extremely cost conscious. Effective computerised systems and procedures need to be implemented to ensure proper utilisation of limited resources toward quality health care. It becomes even more important when an in-house medical facility is provided by an industry for it s employees, as is the case for Tata Steel. Patient care management in Tata Steel has fully utilised the power of computers in Medicare, whereby network of integrated systems maintaining patient database for the hospital services in the areas of Pathology, Radiology, Medical Research, In-patient Admissions and Billing, Medical Stores & Pharmacy are operational. The implementation of the above modules have evolved user-friendly computerised systems which are loved and cared by all. This paper tries to cover giving an insight to the Hospital Information system implemented at the Tata Main Hospital, which is being fully utilised to provide quality service. The computerised system has enabled the medics to serve their customers with a smile and to meet the corporate objective set by the founder. We do not claim to be unselfish, more generous or more philanthropic than other people. But we think we started on sound and straight forward business principles, considering the interests of the shareholders our own, and the health and welfare of the employees the sure foundation o our prosperity, - JN Tata I. INTRODUCTION Tata Main Hospital (commonly known as TMH) at Jamshedpur caters its services to the employees (around 60,000) of Tata Steel, their families, and dependent relations. It also extends it s facilities to patients coming from in and around Jamshedpur and Associated & Contractor company s. TMH is a eight hundred and thirty five bedded hospital equipped with modern facilities and catering all specialities. Computerisation at TMH has started in a limited way since 1985 when standalone systems were introduced to take care of routine local area needs the emphasis then was mainly on book-keeping activities. Medicare areas were not computerised. A need for an integrated patient management system was felt and a Information System Planning (ISP) study was conducted. Since 1996 an integrated information system have been implemented in the areas of Pathology, Radiology, Medical Research, Medical Stores & Pharmacy, Inpatient Admissions & Billing. On-line sharing of information has made extension of the existing system to ICU and wards possible, whereby test results can be made available on-line enabling prompt remedial action by doctors. * MD, Registrar, Dept of Pathology, ** MSc (Computer) Dy Manager, Information Technology System, *** BE, Senior Divisional Manager, Information Technology System 70

2 Effective systems and procedures have helped TMH administration in achieving and fulfilling their quality objectives - We shall constantly strive to provide our employees, their families and dependent relations prompt and expert comprehensive health care services in a customer friendly environment. II. OBJECTIVES OF THE SYSTEM TMH is a large hospital which devotes considerable emphasis on Patient Care. The short term objectives of the on-line computerised system in TMH 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 are to build and maintain a patient database for analysis of data to facilitate decision making process. III. SCOPE OF THE SYSTEM As a prelude to computerisation a comprehensive requirement analysis study was conducted by a team of TMH staff and IT staff to ascertain the various needs for computerisation. Patient Care related areas were given priority in order to achieve the objectives. TMH has computerised the following functions: - Admissions/Discharges/Transfers - Pathology test result information - Radiology test with appointment scheduling - Special test Information system at Medical Research - Inventory maintenance of medicines & other appliances - Issue of medicines of patient - Communications with external world using and web technology - Patient billing IV. METHODOLOGY ADOPTED 71 As per the ISO 9000 standards a Project team was formed for monitoring and managing the computerisation project on schedule. The team comprised of Head of Departments, Key users consisting of doctors, Accountants etc, each from various functional areas along with IT personnel. General Manager (Medical Services) called sponsor set directives and reviewed project. Technical guidance was provided by Senior IT personnel. The project execution methodology was carefully designed to incorporate almost all the essentials of comprehensive methodology of ITS, which is an ISO 9001 certified unit. Main emphasis is given to Joint Application Development (JAD) where approach was participative, user driven, highly interactive, stress on quality, use of productive tools, phase approach etc. Each phase end was certified by key users, Steering Committee members, and finally by Central Quality Assurance (CQA) group at ITS. V. BUSINESS PROCESS RE-ENGINEERING (BPR) In order to achieve the objectives through computerisation, each functional business process was studied and then questioned. Radical changes were brought about by re-engineering the processes and simplifying the existing business procedures to meet the needs of computerisation. A few example of re-engineered processes are indicated in Table -1. VI. FUNCTIONAL COVERAGE A brief outline of the functions covered in various modules is given below. Admissions/Discharges/Transfers: This module caters to the in-patient admissions and discharges or transfers from various wards/ cabins/icu. Registration of casualty/ observation patients. Birth and death records maintenance. On-line and web based enquiry facility. Daily bed availability and monthly Management Information System (MIS) statistical reports.

3 Accounts Billing: This module caters to money receipt generation and instant bill calculation for paying cases. Medicine, Pathology, Radiology, MRC charges are available on-line for billing. Monthly generation of reports for recovery from Tata Steel employees/associated and Contractor companies/govt. Employees. Pathology: This module caters to pathological test request handling and consolidated result entry. Worksheets are printed by various sections of path lab (i.e Bio-chemistry, Histology, clinical, haematology etc) to perform the respective tests. 911 blood autoanalyser has been linked with RS 6000 for data transfer eliminating data entry and increasing data accuracy and timeliness. Medical Stores: This module maintains medicine and other appliances, close monitoring of inventory with the help of online stock enquiry. Issues of medicines driven by expiry of medicines and maintenance of batch details. Analysis of movement, consumption and indent data available with improved vendor control supported by VED/ ABC analysis and vendor rating facility. Pharmacy: This module caters to accounting of medicines dispensed to patients from counters maintained by automatic indenting from substore. Control of medicine over dosage and drug to drug interactions are maintained. Statistical analysis available on drugwise/ doctorwise. Radiology: This module caters to accounting of X-ray films, scheduling of appointments, and reporting of X-ray requests and result entry. Linked with Billing module. Statistical analysis of graphical data doctorwise/unitwise/ type of X-ray film wise utilisation versus wastage etc. Medical Research: This module caters to request and result entry for special tests conducted such as T3, T4, TSH, HIV, Hepatitis, FSH etc. Linked with Billing module. Statistical analysis of data patientwise/testwise etc. Communications: In order to extend the reach and range of the existing facilities to the outside world, TMH has been linked with Internet, 72 Intranet and facilities. The viewing and printing facilities of test results are available at remote locations such as Jamadoba and West Bokaro, also daily admissions and discharges are available on the Tata Steel web page using intranet facility. Future Plan: With the existing systems having stabilised, OPD block computerisation is planned for the future. VII. PATIENT CARE FOCUS Special attention was given to meet the quality objectives of TMH. We shall constantly strive to provide our employees, their families and dependent relations prompt and expert comprehensive health care services in a customer friendly environment A few examples are illustrated below: - Retrieval of reference data (i.e name, age, sex, dept) for an employee to facilitate online printing of case sheet at the time of admission, reducing the patient admit time. - On-line enquiry as well as web based new admissions information availability, improved customer service. - Computer printed stickers for blood samples eliminated any chance of sample mixup. - Single requisition entry for all tests has increased time for doctors at attend to patients. - On request test result print/reprint facility eliminated the patient waiting time for report collection. - Retrieval of past results for statistical analysis of data such as incidence rate of occupational hazard like asbestosis Ca lung in workers of Tata Steel and Incidence rate of breast cancer below 40 years of age of No false positive or negative cases in Fine Needle Aspiration Cytology (FNAC)

4 - On-line scheduling for appointments by doctors eliminated patient waiting time. - Early alarm system for notification on expiry of medicines. - Automatic declaration of medicine as obsolete after expiry date. - Viewing/printing facility of test results from wards/icu/remote locations to effect prompt action by doctor - Data bank of Medical Research cases such as records of HIV positive cases and how many turned down to be full bloom AIDS cases and in industrial setup the usefulness of T3, T4, TSH in patient for better followups. - Instant billing facility improved customer service and revenue savings to hospital - Warnings during issue of medicines on Overdose of medicines eg. Chloramphenical, Cotrimoxazole and drug to drug interactions eg. Chloramphenical with Cotrimoxazole etc. avoiding any chance of adverse reactions to patients. - Statistical Analysis of data for proper utilisation of resources (MIS) - doctorwise tests conducted - Patientwise medicines consumed - Counterwise load distribution - Demographic analysis of diseases (eg. agewise, sexwise, disease profile, test profile etc) eg. no. of different malignancies with agewise, sexwise distributions, No. of malaria positive cases, No. of Vibrio cholerae cases etc. On account of the user friendliness the computerised system thus evolved were not still-born system (not used right from the beginning) or an orphan system (not owned by anybody) which has helped the hospital doctors to provide quality service to patients. VIII. KEY PERFORMANCE INDICATORS (KPI) Indicators (KPI s) showed remarkable improvements after computerisation. A few of the salient one s are listed in Table 2. IX. CONCLUSION It can thus 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 upgradable. 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 utilisation of facilities. REFERENCES 1. Prabhakar A & Visweswara GH: Datanet Corp Ltd., Bangalore: IT - Applications in Hospitals, Computer Applications in Hospital (ISHA), chapter Jain Vipul: Director Kale Consultants Pvt Ltd. Bombay: Computers in health care, Computer Applications in hospital (ISHA), chapter C 1979 Datapro Research Corporation, Delarn, NJ 08075, USA: Applications overview: Medical and Healthcare, Computer Applications in hospital (ISHA) chapter 12. The benefits of computerisation come from better management through informed decision making. The Key Performance 73

5 Process Table 1 Benefits - Laboratory test requisition forms were reduced to a single format instead of three - Laboratory test results were consolidated and printed on a single sheet - Laboratory test results were printed only on request - On-line system extended to ICU/hospital wards for test result viewing - Linking 911 Blood autoanalyser with RS 6000 where by data entry was eliminated - Sticker printing was introduced at the time of registration and blood sample collection - Linking RS 6000 with 1MB mainframe for transfer of employee data - Linking RS 6000 on-line with the Tata Steel network Table - 2 Improvement in doctor's productivity Reduced patient waiting time Eliminating wastage of stationary Prompt medical attention Accuracy and timeliness of data Eliminating any possibility of mixup of blood samples Authorisation check & accurate billing Extending viewing & printing of test results at remote locations Key Performance Indicator Before After Computer Computer - Average patient waiting 10 mins 5 mins. time at Admission - Avg. no. of pathlab requisitions 3 nos. 1 nos. - Avg. retrieval time of pathlab test 5 mins 0.5 mins result reports - Back log of bills 5 months nil - Medical Stores inventory 2.46 mon 1.7months - Monthly closing cycle time of 3 days same day - Medical Stores Inventory - Avg. monthly consumption of akhs akhs Revenue Benefits Reduction in patient waiting time Saving of Stations Reduction in patient waiting time Revenue losses eliminated Better system availability Better system availability Revenue savings 74