Using IT Wisely

The HIS system at Paras Hospital is clearly focussed on patient care, says Sonal Vij

Rarely one comes across a healthcare player who not does flaunt about the purchase of international softwares. And often you end up wondering as to how much does will the patient be benefited by these fancy softwares? Well, Gurgaon-based Paras Hospitals (PH) is different. The HIS here is a clear example of a simple IT system directed at the patient. This theory stems from the top. Explains Dr Dharminder Nagar, Managing Director, Paras Hospitals, "Every decision (including IT) is taken through the patient's prism. We don't invest in unnecessary technologies just to copy our competitors. Instead, we focus on technologies that will benefit the patient." He adds that buying expensive softwares would add to the cost of healthcare. Ultimately that means increase in the cost of healthcare delivery to the patient.

A Careful Choice

Right from the beginning, the hospital was conscious of the IT needs. In an era where the market is flooded with various kinds of Healthcare ERPs, one of the toughest decisions for any healthcare player is to choose the best-suited HIS. Apart from the capabilities to match with the current business processes and procedures, one needs to do the cost-benefit analysis.

Explaining the choice procedure, Prashant Singh, AGM Technology and Operations, Paras Hospitals says, "We visited many big hospitals and saw the problems that international systems posed. We realised that (other than being expensive), these international systems were complex and there was always an instauration problem." After a careful scrutiny, other than buying an international IT system, PH chose Delhi-based-Akhil Systems, a professional software company which specialises in delivering Hospital Information System (HIS), Electronic Medical Record (EMR), Laboratory Information System (LIS) and Radiology Information System (RIS). The initial investment in IT was Rs 40 lakh.

Singh explains the choice over other systems, "We had selected Akhil systems after analysing the important selection criteria like the ability to cater to the MIS needs of the organisation which may not be required today but the need could be felt in the future."

Right now, PH has implemented these functionalities from Akhil Systems: front office, electronic patient medical record, diagnostic modules, inventory and pharmacy management, finance and budgeting, human resource and payroll, back office modules, management information system, admin modules and interfaces with HIS.

The Use

The clinical information system in the HIS enables the doctors to have a quick review of the previous medical history of patients. It also facilitates storage of digitised images of films and patient photographs album for each patient with patient and date sequence.

It is also integrated with appointments, OPD billing, laboratory, diagnostics imaging and A/T/D modules. The availability of pre-defined medical record formats for each discipline makes easy storage and retrieval facilitates in maintenance of electronic record of the patient medical history, family history, allergies, diagnosis and treatment advised to the patient each visit wise. Also, if the doctor at any point of time wants to view the patient records or patient investigation results, s/ he doesn't have to wait for the nurses to get the results. S/ he can view the results on the computer screen. All the departments are linked to the system. For instance, blood bank, pharmacy, laboratories are interconnected. In any critical situation where quick decisions are required, this feature is particularly useful. "Also, the inpatient records are available after discharge from the hospital in the subsequent visits. The doctor can update patient disease diagnosis and medication details in the smart card for ready reference and can also send patient records through web to another consultant at different location for cross consultation," shares Singh.

The in-patient module of the HIS performs three different functions- patient administration, patient information and nursing care activities management. It also interacts with other modules such as diagnostic centres, blood bank, pharmacy, dietary management, OT and so on. The nurses allocate and release beds and notify transfers, discharges using the HIS. The patient data regarding monitoring progress, history, drugs prescriptions and doctor's instructions, etc. are noted and discharge summary is prepared simultaneously.

The nurses also enter service charge slips for all the services offered to each patient in the ward for patient billing purposes. The requests entered by the nurse for the patients are automatically printed in the concerned centres printer and message is flashed for the request. The hospital has also developed an in-house system which acts as a substitute to PACS. "We use this as a substitute to PACS to save costs," says Singh.

Bar Coding

"With the MIS in place, I don't have to rely on huge files and ask other people for data" - Dr Dharminder Nagar Managing Director Paras Hospitals

"We had selected Akhil systems after analysing the important selection criteria like the ability to cater to the MIS needs of the organisation" - Prashant Singh AGM Technology and Operations Paras Hospitals

To minimise the errors, PH has incorporated an advanced solution of bar coding for the tracking of patient details and the related diagnostic samples. When a patient comes for the first time in PH s/, he gets registered and a unique registration number is generated. Every subsequent visit of the patient is linked with this unique registration number. Front office executives generate bar-coded sticker for the patient, which generally contains patient's name, registration number, and other important details along with the consultant details. Once the consultant advices investigations, the patient goes to billing counter where the respective investigations are ordered and when patient goes to sample collection counter, the technician gets all relevant information by just scanning the bar-coded labels.

He then executes the orders and in-turn the system generates bar-coded labels for the sample containers, which avoids the chances of any human error. Even in pathology labs, the technicians only scan the labels on sample containers to get all relevant information automatically fed into HIS.

Even diagnostic tools/ equipment are interfaced and the results are automatically thrown into the HIS. "This minimises the chance of human error and ensures security of the reports," shares Singh.

Pharmacy Retailing

Batch number errors (in pharmacy) are one of the most common errors in almost all the hospitals. To tackle this, PH has introduced the barcode techniques in pharmacy retailing. Appropriate symbols have been used to overcome the practical difficulties. A small barcode sticker has been designed which can even be pasted on small size medicine strips. "With the use of small size stickers we can even sell the cut medicines, as it is applicable and important in Indian scenario." With the implementation of bar code stickers, PH could successfully reduce the errors to negligible level and could speed up the turn-around time for medicine dispensing up-to 60 per cent.

Technology in Management

Unlike trust run hospitals, corporate hospitals need to have different decision making and analytical report to have the better understanding of the hospital as a business unit. Lot of healthcare KPIs are required to be captured to accomplish the same. "We have been able to see the online reports through HIS which includes important KPIs like procedure wise contribution, department wise contribution, drilled down overview of the clinical departments, different case mix reports etc," shares Singh. "With the MIS in place, I don't have to rely on huge files and ask other people for data. Instead now that I already have the entire data available at the click of a mouse, I can question everyone," explains Dr Nagar.

Backups

Bar coding being done in pharmacy department of the hospital

A good IT system creates full automation

PH has extensively worked on HIS rights management and could even achieve the option level security to restrict the users for viewing or using the non-related activities or MIS. Since the records are crucial a strong backup is indispensable. "Besides scheduled backups we are using the database server cluster to prevent any kind of data loss due to hardware failure," explains Singh. In the event of hardware failure the other secondary can automatically takeover without any manual intervention.

Challenges

When one talks about going for the HIS implementation the biggest challenge is to define the requirements after mapping with different processes and procedures. "You need to have a perfect team or we can call it as 'HIS governing body' having experts from all the fields like clinical, administration, IT, finance etc to make the HIS as useful to them as possible," says Singh. He adds that involving nurses for doing HIS entries is another challenge as most of them are not IT savvy and not used to keyboard typing. EMR from the software point of view is so simple but viewing from the practical point of view is still a challenge in Indian healthcare industry. "You need to involve consultants to do lot of computer entries who are used to write manual prescription," he adds. Implementation of hospital wide EMR with increased cost is really a challenge in Indian healthcare context where providing affordable healthcare delivery is a challenge.

The Road Ahead

So far, the hospital has been successful in implementing all the modules as decided in the first phase. Now, it plans to go for the integrated finance module which would be able to take the auto entries from all the supporting modules to enable the management to see the cost centre and profit centre wise report, implement various financial controls and different levels, capturing of various clinical parameters, pharmacy indenting from wards, web uploading of diagnostic reports etc.

Also, the hospital is studying and analysing the implementation of EMR. "I am yet to see complete implementation of EMR," says Dr Nagar. It will be implemented by the beginning to next year. Right now, the annual expenditure is Rs 25 lakh. This is likely to increase by 15 per cent with implementation of EMR.

sonal.vij@expressindia.com