The e-HIS Effect

Gurgaon-based Artemis Health Institute is one of those rare greenfield projects in India, which already had IT in its mind before going operational. Sonal Vij tells you why it was a wise decision to integrate IT right from the start

Gone are the days of hand-scrawled notes, scribbled prescrip-tions, big diagnostic charts, patient queues, and lost patient charts. Today, all this information and critical details are no more than a keyboard click away and one of the finest examples to display IT efficiency is Gurgaon-based Artemis Health Institute (AHI).

Realising how IT is fast bringing a makeover of the healthcare industry and changing the face of traditional doctor-patient relationship, the management at AHI has always made sure to keep the hospital as paperless as possible. Knowing that IT is the key to gain optimum operational efficiency, Artemis has implemented Hospital Information System (HIS) since its inception in July, 2007.

Commander Jose Verghese, COO, AHI, shares, "The new player always has an advantage of learning from mistakes of the previous players." Instead of first building a process and then implementing a HIS system, the hospital built in all the processes with the HIS.

The Vendor

The hospital makes use of eHIS 5.0 version which is provided by IBA Health, a leading health IT solutions company with a strong international footprint. The hospital has customised this HIS to suit its needs and make the usage as simple as possible for the doctors and the medical staff. Emphasis is laid to use the HIS system for all functions in the hospital.

"Artemis has a one-stop data warehouse of records of patients and treatment histories that can be consulted by authorised experts, keeping patient confidentiality uppermost in mind. AHI has integrated almost everything in the hospital, right from the front office registration to doctor consultation, investigations, the complete in patient treatment, more so even the laundry is no stranger to it," says Commander Verghese. Among the many modules implemented, the main ones are IP, OP, ER, PCS, clinical information, blood bank, OT, diet, laundry, pharmacy and billing.

Patient-Centric Approach

"The new player always has an advantage of learning from mistakes of the previous players" - Commander Jose Verghese COO Artemis Health Institute

"Integration of PACS and SAP ensure medical records & financial transactions are available on real-time basis" - Vinod Kalra Project Manager SAP

Every patient is allocated a unique lifetime registration number free-of-cost along with a registration card. This unique identification number provides the complete details of the patient's medical history as recorded in eHIS at any point of time during subsequent visits. Some excellent IT inputs/ facilities comprise the twin display facility at the main registration desk, wherein when the patient details are being fed into the system, the patient/ relative can see it and correct the details if necessary.

"At every touch point of the patient on his entire movement from desk-to-desk, the vitals of patients are entered/ checked beforehand and logged into the HIS. This allows the subsequent touch point to understand the previous observations/ views/ recommendations to take an appropriate action when the patient comes to that touch point/desk," explains Manu Deep, IT Executive. For instance, the vitals entered by the nursing staff at the OPD station are available to the doctor on his eHIS screen and hence the doctor can immediately diagnose the patient and move on to the next patient.

This process utilises the waiting time of the patients and allows doctors to concentrate more on diagnosis. Attendants, nurses and doctors, also help the HIS monitor each movement of the patient, by continuously feeding in the required details as well as logging the time of admittance, consultation and the whole gamut which helps provides intelligence on factors such as average wait time, consultation time and so on. The HIS is equipped to allow doctors to access results of all tests, images from radiology and so on of their patients.

The billing is not directly a part of the clinical processes. When a doctor suggests some tests for the patient, the patient goes and pays at the registration counter. When he/she pays, their details are fed into the HIS. When they go to the diagnostic area, their names automatically appear if the test is already paid for. The diagnostic services will be provided against the account. In case the patient hasn't paid, the name will not appear.

Towards Automation

The hospital has made every effort to ensure automation."The USP of the HIS implementation is its integration with PACS and SAP seamlessly to ensure that the entire patient medical records and financial transactions are available online on real-time basis," says Vinod Kalra, Project Manager, SAP.

The complete hospital workflow, right from patient registration to discharge, including consultation, prescription, investigations, doctor and nursing notes, billing, inventory management, etc, is automated.

Patient safety in terms of correct medication, correct dose, allergies to various drugs, etc is taken care of by HIS. AHI has added cathlab, endoscopy, gamma-camera, PET-CT, and all radiology modalities in PACS— making the images available online in digital format. Also, complete patient monitoring system is available online from any corner of the hospital for the doctors to have a look at patient's condition anytime.

"Implementation of HIS along with integration of PACS is to create a paperless environment in which medical and nursing staff can work online in a more cost-effective and accurate manner. The aim of this implementation is to enhance patient safety with generation of instant alerts and reducing medication errors," says Verghese. This system has eliminated the need for large medical record charts as everything has been posted online with due care for data security. However, it is practically impossible to think of a completely 'paperless' hospital in India.

Reasons Verghese, "You cannot go totally paperless due to some legal constraints. Digital signatures are not yet legalised in India. So, if we are taking consent from the patient for any procedure, it has to be on hard copy and it has to be stored alongside the medical record. All other patient records are available online."

Care Delivery

Doctors as well as other medical staff can easily follow-up a patient's medical history. The doctors can access the results of all tests, images from radiology and other patient details using their ID. Images of radiology, endoscopy, and echocardiography can also be accessed by doctors anytime within few clicks. At any point in time, real-time data is available from the ICU, bedside monitors in the hospital.

The head surgeon can also view a real-time video of a surgical procedure being performed by his team from his personal chamber. "The HIS server uses 760 mb per day and the PACS server about four GB daily. The facility also has three terabytes of storage area network," informs Deep.

Each ICU bed has a bedside laptop. The nurses and doctor's access and update patient vitals and details on the HIS. When the doctors go for patient visits, the doctor directly enters the details into the HIS.

One of the unique technologies is pneumatic chutes in the hospital connecting the wards to the laboratory and pharmacy. "The test samples are collected and bar-coded from the patient bedside and sent via the chute to the lab where the tests are done. The pharmacy too sends medication required for patients to the wards via the pneumatic chute, thus reducing the need for movement and saving on time," explains Deep.

ERP-SAP

Apart from HIS and PACS implementation, AHI has implemented SAP for its material and finance management operations to track the vendor and customer financial transactions. SAP is also being used to manage the inventory of the medical and non-medical items to ensure that the right medicine is available at the right time. This is being achieved by implementation of Material Requirement Plan (MRP) that runs within SAP.

Technical Issues

The initial stages were difficult. The hospital had a team of eight people from iSOFT who were at the hospital for four months — including technical persons developing the interface, a team from Philips, who were the primary suppliers for modalities, a team of biomedical engineers, and various departmental users. While interfacing there were problems though, not major ones.

The Experience

The biggest challenge to any HIS system is resistance from the user. "However, the Artemis management was very clear with its vision to use EMR. Its message was very clear to all the doctors, the nurses, the technicians, front office, inventory and store employees," says Verghese. Dealing with doctors and nurses was a challenge. "There were nurses who had never touched a computer in their life and we had to plan their training accordingly," says Deep. Even the doctors were initially reluctant, but now they enter the data themselves.

"Initially when we started implementing, we did not have data, being a greenfield project. Each department was asked to collect and feed their own data into the system. This was done in a specific format provided by iSOFT. After the data was collected, it needed to be validated, checked and then entered. Laboratory and radiology departments entered all the data, so it worked well," says Deep. Other modules' data was entered by data entry operators, which took quite some time to correct.

The biggest challenge for any hospital using HIS is to impart training to the end-users. There were differences in opinion of the users. However, today nearly all the doctors are happily using the HIS with complete EMR available online at the click of a button.

Future Plans

Having already automised to such a large extent, AHI is planning to implement the portals for making online registrations, lab/investigation reservations, payment gateway and online information availability to the patients about his/ her complete health history in the hospital. "This is a priority for us and will be done by end of this year," assures Verghese.

Another plan is to integrate the TPAs online (as soon as TPAs are ready) with the HIS system so that the insurance approvals happen at minimum possible time and thereby minimise patient woes of waiting for the approvals before final settlement/ discharge.

The IT budget for the hospital project was Rs 6.5 crore, which was effectively used in equipping the hospital with TFT monitors and small desktop machines. Thus, there is no bulky equipment anywhere.

The hospital is truly reaping the benefits of the good IT system and making it reach the end user!

sonal.vij@expressindia.com