HOSPITAL

INFORMATION
SYSTEM-An Overview

By
Shwetnisha Bose
Post Graduate Diploma In Hospital
Management (2010-12)
Administrative Staff College Of India
Hyderabad
 ABSTRACT
Healthcare worldwide is constantly undergoing changes due to new research
findings, new medical technologies and new business models. These
challenges are further compounded by the fact that healthcare is an
information intensive field. Data must be timely, accurate and reliable - it
could make the difference between life and death. The benefits of Information
Technology can effectively address the challenges faced by healthcare
providers. Information Technology solutions in healthcare helps to provide
enhanced care to patients while conforming to present and emerging standards
and regulations. It also has critical social relevance in providing accurate
monitoring and compliance with best procedures and practices.

Hospitals are very expensive to build and to operate. Administrators and

professionals have to be extremely cost conscious. Effective computerized
systems and procedures need to be implemented to ensure proper utilization of
limited resources toward quality health care. Patient care management in
present day hospitals has fully utilized the power of computers in Medicare,
whereby network of integrated systems maintaining patient database for the
hospital services in various department of the hospitals which includes
Pathology, Radiology, In-patient Admissions and Billing, Medical Stores,
ICU, Wards, medical records, pharmacy etc.

This paper tries to cover giving an insight to the Hospital Information system,
its application to provide quality service, emerging trends in the areas of HIS,
challenges faced by the consumers and recommendations to improvise it and
future scope of HIS.

INTRODUCTION
A Hospital Information system is a computerized system designed to meet the
information needs of the 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, Outcome
assessment and quality control, Pharmacy ordering, Decision support, Finance
and accounting, Supplies, inventory, maintenance and orders management etc.

Over the last few decades, medical sciences have made great strides leading to
radical improvements in the modes of investigations, therapeutic activities and
surgical procedures. This has enhanced the imperative need to have authentic
and accurate information system.
.Advantage of using HIS

 Hospital Information System (HIS) is vital to decision making and

plays a crucial role in the success of the organization
 Managers, Clinicians and other healthcare workers can now access the
information with the help of HIS without delay or errors.
 Improved quality of documentation
 Improved quality of patient care
 Reduced error
 Enhanced ability to track patient record
 Improved Hospital image
 Ensures flawless integration within the various departments of the
hospital

It is no doubt that a carefully planned Hospital Information System and

intelligently used information will be a great asset to any health care industry.

The Hospital Information managers must have the necessary skills to facilitate
and manage this transition and bridge the gap in the changing patterns switch
over to 21st century.

HIS Objectives

1. Supply Information for decision making

– Administrative
– Clinical
2. Better communication environment
3. Data warehouse for medical research

CLASSIFICATION OF HIS
The HIS can be classified into

 Centralized or decentralized
 Business-oriented or patient-oriented
 Terminals or workstations
Centralized or decentralized

Centralized: Information is kept primarily in a central computer.

Decentralized: Information is distributed over a number of workstations or
servers located all around the hospital.
Partially centralized: Centralized certain functions while others are
individualized in some units.

Business-oriented or Patient-oriented

Both these types of systems handle patient information. The orientation of the
original designers may either focus on the patient or on the business

Terminals or workstations

Terminals They are PCs that 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 (the main) computer. (No application
installed).

Workstations 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
especially powerful microcomputers.)

LITERATURE REVIEW
Information technology (IT)-based applications in healthcare have existed for
more than three decades and have gained widespread use. Nowadays, it is hard
to imagine healthcare without IT-based applications for both the accumulation
and interchange of clinical information. This is in part because IT has been
recognized as an “enabler,” that is, as a tool that offers solutions to the
problem of the increasing accumulation of patient data. Because of their
central role enabling the diverse use of information, IT systems ensure the
timely and accurate collection and exchange of information, and thus a more
efficient use of the scarce resources of healthcare organizations. With an
increased need for the implementation of IT in all healthcare domains—such
as primary healthcare and clinical settings or home healthcare environments—
for the purpose of providing an optimal use of resource investment, its use is
expected to rise. Evaluating such IT applications to help decision makers
acquire knowledge about the impact of IT-based systems therefore becomes a
key issue to all organizations that aim to implement any new application.

The following names are also used to describe HIS:

o Electronic patient record (EPR)

o Computerized patient record (also known as HIS)
o Computer-based patient record system (HIS)
o Computer-based patient record-type system (HIS-type system)
o Electronic patient record (EPR)
o Virtual patient record (VPR)
o Virtual health record (VHR)
o Electronic health record (EHR)
o Lifetime data repository (LDR)
o Electronic medical infrastructure (EMI)
o Automated medical record (AMR)
o Computerized medical record (CMR)
o Patient care information systems (PCIS)

Healthcare is, in large part, an information driven field. Clinical practices

rely heavily on the collection and analysis of medical data for decision-
making abilities when caring for patients. The patient record is the
compilation of medical data and information in its numerous forms, and is
the cornerstone of healthcare information systems, or HIS, which are
capable of having a significant, positive impact on patient care within
healthcare settings. HIS have been recommended for adoption by the
Institute of Medicine as a strategy in improving the quality of patient
records. In fact, improvement in quality of care is a foremost concern and
driving force in the use of HIS.

Characterizing healthcare information systems

Medical informatics

The development of health information systems, or HIS, takes place within the
field of medical informatics. Medical informatics is the study of the
management and use of healthcare and biomedical information, and aims to
assure that such information is used as effectively as possible for the greatest
benefit to patients’ health. Medical informatics encourages improved
healthcare through improved quality of medical records. Medical informatics
also focuses on the development of HIS that may be more easily integrated
into the clinical setting for use by healthcare professionals, with attention to
assured patient privacy and confidentiality This field is centred on the
development of standards in medical terminology and data collection, which
are vital in any attempt to aggregate and share data from various locations or
across different HIS.

The nature and potential of healthcare information systems

The various forms of HIS are best described as a continuum. This continuum
has five stages, ranging in increasing complexity and difficulty in successful
implementation. While stage one of the continuums uses the HIS in tandem
with the traditional paper based system, stages two through five increasingly
move away from paper based medical records to those that are completely
electronic and capable of being linked with other clinics and hospitals.
Decision support systems, capable of notifying healthcare professionals of
errors in patient care, are at this end of the continuum.

In general, the ideal HIS provides quick access to a patient’s full medical
history and health information, and accessibility to data that are not easily
found within the patient chart. This improves the quality of patient care
through improved patient records. HIS help ensure that patient data are
accurate through quality assurance checks. HIS also allow healthcare
professionals to more easily and more quickly track the quality of patient care
provided and measure changes in health status through the use of automated
summary reports which examine patient data according to disease, procedure,
provider, and quality assurance measures. In this way, the HIS allows
healthcare professionals to routinely monitor and ask questions about their
patient populations that were previously very time consuming, if not
impossible, to answer. Some HIS allow users to quickly generate reminder
letters to be mailed to patients to inform them of needed laboratory work,
services, and preventative care measures.
In short, a successful HIS must enhance the quality of work within the clinical
setting and promote improved patient care.
 APPLICATION OF HIS
.
Decision Support System

This is required to allow retrieval of pertinent information to assess

operational effectiveness. It allows the investigation of physician utilization,
revenue analysis, census comparison etc.
Laboratory Information System

The LIS is required to be fully integrated with the hospital information system
and to include control on laboratory workflow from requisition and specimen
collection and processing to results reporting. This includes the services,
chemistry, microbiology, blood bank etc.

Order Entry / Results Reporting

It includes online communication of physician orders, and patient information

between nursing and ancillary departments.

Pharmacy Information System

Pharmacy information system includes medication administration record,

patient profiles, medication charges, inventory control etc.

Human Resources

This is required for managing entire functions of human resources.

Materials Management (Purchasing)

Materials Management module helps in procurement control and manages

inventory, supplies and equipment throughout the Hospital.

Nursing Care and Management

This handles all the processes involved in the daily transactions that occur in a
ward, these transactions involve test requisitions placed for the patient,
medicines consumed by the patient, bedside procedures performed, medical
equipment connected to the patient , and recording of all visits by the doctor.
Furthermore, it allows for the capturing of nursing assessment data, nursing
plans and checklists, nursing charting/progress notes, nurse management and
nursing quality assurance.
Physicians’ Access and Notes

The purpose of using this is to provide physicians associated with the

Hospital, an easy mean of communicating with the ‘Hospital Information
System’. Simultaneously the system should provide a facility for the Doctors
to organize their notes and activities within the Hospital.

Accident and Emergency Management

The Accident and Emergency (A&E) module allows the Hospital to record
data accurately and quickly for patient treatment. It also allows users to record
casualty details, and `discharge status’

Inpatient Management (ADT)

It supports two main functions: the administration of wards (nursing units) and
the handling of admissions, discharge and transfer of patients in those wards.

Medical Records

It is required, to be fully, integrated with, inpatient management and patient

accounting. It supports the operational needs of a modern medical records
department including transcription, case indexing, abstracting, statistical
reporting, and charge location, with complete integration with patient billing
function.

Outpatient Management

The Outpatients management supports the setting up and maintenance of

clinics and the administration and scheduling of outpatient appointments.

Patient Registration System

The Hospital needs a registration system, which will utilize a central patient
registration database that contains basic information on each patient. The
patient registration database will serve as a Master Patient Index supports all
other systems in patient identification. The system allows the search of a
patient record by using any combination of fields.

House Keeping and Laundry

A sub module is needed to help the Hospital schedule House Keeping

activities and follow up on incurred cost and progress of work.
 LATEST TRENDS IN HEALTHCARE IT

E-prescribing

It involves prescription orders that clinicians input electronically, which are

then transmitted to the pharmacy. It provides decision support to the clinician,
such as drug interaction flags and allergy-related information is usually
included. E-prescribing eliminates hard-to-read handwritten prescriptions, as
well as errors in dispensing (such as wrong drug or contraindicated drug).

Electronic clinical notes systems

It includes information on a patient’s demographics, medical history,

physician/nurse notes, and/or follow-up orders.

Electronic lab orders

This computerizes ordering of lab tests.

Electronic lab results

It may allow quicker receipt and review of results by clinicians; this process
usually includes decision support, such as highlighting results out of the
normal range.

Electronic images available throughout a hospital

It helps in electronically storing of images (CT, MRI, PET scans) available to

the medical team beyond the doors of the radiology department.

Electronic reminders for guideline-based interventions

It assists physicians by proactively suggesting care that appears needed based

on evidence-based knowledge and patient-specific data.

CHALLENGES FACED

Though HIS has proved to be very beneficial in proper functions and

operational efficiency in many departments of a hospital, there has been many
challenges which are being faced by these departments.
1. Sometimes due to user end error the IT department faces stiff challenges.

2. The speed of the server may become slow sometimes if overloaded with
data.

3. Redundancies are possible e.g. Bill may get generated twice.

4. In case of searching an investigation/ procedure/drugs etc. exact names have

to be typed.

5. The transactions take lot of time to update.

6. If the document is not saved and the system freezes, it takes time and effort
to rewrite the document.

7. Number of cases done per month cannot be found using HIS, reason being
for one case if two procedures are used, the system when updated takes it as
two cases. This is one of the constraints in few of the available software.

8. Security issues are a major concern.

9. Mindset of doctors who have been practicing the paper-pen format is the
biggest challenge.

10. Electronic Medical Records are not accepted in legal cases.

SUCCESSFUL IMPLEMENTATION OF HIS

End-users must be willing to support the implementation of HIS

Healthcare professionals must be involved in design and implementation of

the system

Clinicians must be flexible and willing to change workflow processes.

IT Department should ensure fast, reliable and easily accessible system.

It should also provide ongoing support along with user training

The Hospital should be committed to workflow changes.

 TOWARDS THE FUTURE

The global Hospital Information Systems (HIS) market was valued at $7.4
billion in 2010, and is forecast to grow at a Compound Annual Growth Rate
(CAGR) of 10% to reach about $14.7 billion by 2017. The high growth
forecast for the period 2010-2017 is significantly influenced by accelerated
efforts from the public and private sectors around the world to contain rising
healthcare costs and enhance quality of care. The inflow of key Information
Technology (IT) technologies such as dictation and speech recognition
solutions, and mobile healthcare solutions into the healthcare market space
will also contribute substantially to growth prospects in this market. These
technological advancements attempt to offset major deterrents to IT adoption
in healthcare settings, such as significant upfront investments and ineptitude of
medical professionals, with large electronic data entry and handling. Rapid
adoption in emerging economies due to enhanced focus of key healthcare IT
players will also accelerate growth of the HIS market. With the concept of
interconnected healthcare systems seeming to materialize, starting with the US
healthcare IT market; vendors have accelerated their efforts in assimilating
necessary capabilities to tap the significant market potential. Intense market
consolidation activity has resurfaced in the last two years.

CONCLUSION

.Information Technology solutions in healthcare impact the process of Care

Delivery, which is the collaborative effort of different departments and
persons within a hospital.It has also helped in improving clinical, operational
and financial outcomes of healthcare providers.

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.

Finally a 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.
 REFERENCES

1. Source of data: AMRI Hospitals, Kolkata

2. Introduction to Hospital information system (Module M30c)

http://courses.wccnet.edu

3. Barriers to the Successful Implementation of Healthcare Information

Systems by Adam Baus West Virginia University, Department of Community
Medicine Office of Health Services Research

4. Methods to Evaluate Health information Systems in Healthcare

Settings: A Literature Review by Bahlol Rahimi & Vivian Vimarlund.

5. http://mathematica-mpr.net

6. http://www.rheumatology.org

7. http://www.emrconsultant.com/education/hospital-information-systems

8. http://www.biohealthmatics.com/technologies/his

9. http://www.indmedica.com/journals.php

10. http://www.teletrader.com/_news/newsdetail.asp?id=14157250