Focus

Paving Way for Digitisation

With 29 modules already in place and PACS on its agenda, the 200-bed Breach Candy Hospital is on its way to complete digitisation, says Sonal Shukla

Mumbai-based Breach Candy hospital, a recognised healthcare institution, known especially for its maternity and critical care, is fast transforming into a strong IT-enabled hospital. The initiative taken by the hospital to implement the Hospital Management Information System (HMIS) in 2007, with the planned investment, has bore fruits with 29 essential modules being implemented and going online from April 1, 2008. The 200-bed hospital is all gung-ho about its latest IT savvy avatar and is shortly going for more advanced modules like PACS and SMS solutions.

Winds of Change

Before switching to the new HMIS, the hospital had an older version which had non-Windows based applications, with in-house programmers maintaining the software. "The programmers were maintaining the package and new modules were incorporated into the system. Over a period of time, with new requirements it became very tough for us to maintain the system due to lot of burden," shares Rajendra S Kshirsagar, Head-IT, Breach Candy Hospital, Mumbai. Moreover, with the earlier vendor opting out of HMIS solutions, maintaining programmes became tougher. But since the source code (in Informix) was available with the hospital, the HMIS was maintained by the programmers for around four years.

"The HMIS was indigenously customised by in-house programmers in Informix and non-Informix platform. Thus, all user requirements were incorporated in the old HMIS," says Kshirsagar. But the expanding functions and lack of support led to a decision for revamping the HMIS to the next level. The hospital felt the need for a more robust and responding integrated enterprise system that could link with all the systems. The requirement for digitisation in the hospital was in terms of structured workflow, enhanced patient care and satisfaction, improved management tools, effective, economic, timely and manageable data processing and enhanced exchange of information between care givers, patients and statutory authorities.

The new HMIS has helped the hospital in coordinating the various activities involved in successfully running it. "It is almost impossible to run a medium/large hospital without an HMIS. In earlier days, HMIS was developed to handle patient billing, inventory management and managing accounts of the hospital. But with the advent of new technology in terms of patient care as well as in field of computer hardware and programming, it is now possible to automate all the activities of a hospital at a reasonable cost and more importantly increasing the reliability by reduction in errors by providing check reports at various levels," shares Maj Gen Vijay Krishna, CEO, Breach Candy Hospital.

The HMIS in Breach Candy Hospital has so far implemented 29 modules including basic once like ADT, billing, finance, inventory as well as recent and vital once like LIS, pharmacy, charity and OT, required for running this 200- bed hospital, "Wherever possible we have tried to change our business processes as per the HMIS requirement in order to avoid customisation, without compromising on the best practices already in use," says Kshirsagar. The vendor too has a capability to add new modules and programmes as per the market requirements, he further points out.

Implementation & Vendor Selection

"Wherever possible, we have tried to change our business processes as per the HMIS requirement" - Rajendra S Kshirsagar Head-IT Breach Candy Hospital Mumbai

"More than cost benefit, HMIS allows interdepartmental communication and co-ordination" - Maj Gen Vijay Krishna CEO Breach Candy Hospital Mumbai

HMIS was implemented in two phases in the hospital. In the first phase all modules directly related to patient care like ADT, billing, pharmacy, LIS, OT, charity, inventory and finance, totaling to 21 modules, were implemented. Later, within a year's time, remaining modules were implemented. Modules like blood bank, Lab QC, medical record tracking, dietary and nutrition, fixed assets, CSSD, laundry, linen and equipment maintenance, implemented in phase two are handy to particular departments in their day to day operations. The hospital selected 'e-symphony' - a Hyderabad based company as its vendor. Explains Maj Gen Krishna, "Hospitals are a niche area and highly specialised too. There are only few companies in India exclusively working in this space and this company is one of them. When we did this implementation three years ago, we did a thorough research on the major players in this field and chose this vendor on the basis of its expertise in HMIS."

The well-integrated HMIS in the hospital has played a major role in departments like lab, pharmacy and wards with the implementation of specific modules in these areas, by keeping track of information for admission/billing/discharge/ labs/ consultation purchase and inventory/ finance/support services, which gets captured at source. Request for medicine or lab services are sent online, which has indirectly saved a lot of manpower and time in the hospital.

ADT module has catered to patient reservations, admission, transfers and discharges with proper reporting. The billing module takes care of the patient billing based on patient category, for example, cash/credit. It also takes care of TPA/insurance billing with proper interface to the accounts receivable/payable module of finance implemented by the hospital. Following are some modules that have been introduced:

Pharmacy: With the introduction of the pharmacy module, the process of issuing of the drugs from the pharmacy, requisition and dispatch of the medicines has become error-free. "As per our hospital policy, all pharmacy required by in-patients has to be provided by the hospital. Even in rare cases when the item is not available in the pharmacy, it is procured from the market by the pharmacy department and is given to the patient. Thus, this module plays a very important role," shares Maj Gen Krishna. Today, all pharmacy requests are sent through HMIS. Based on type of item or request, for example, narcotics/emergency, the item is displayed in different colour code at the pharmacy. Various reports for dispatch of items ward wise, patient wise, along with MIS reports are available from the module.

Laboratory Information System (LIS): Hospital has LIS module in place through which lab test results are easily captured along with the patient demography. Most of the investigation machines are interfaced with HMIS, on account of which the bar coded samples post processing, are available as ready to view reports. "Of course there are mandatory validations which need to be authorised by the lab personnel without which the report will not be available for viewing to the authorised requesting department user," says Kshirsagar.

Charity Module: The hospital started a separate ward for free and subsidised patients in 1975, before Section 41AA was introduced in the Public Trust Act in 1985. There is a charitable OPD run by the hospital on a daily basis where needy patients are seen free of cost by consultants of all specialties (and medicines are also provided free). Based on yearly income, patients are treated as free or as weaker category wherein some test investigations are provided free of cost and others at subsidised rate. The module takes care of the entire patient billing based on the category of the patient.

OT Module: The implementation of this module streamlined the OT area in the hospital with real-time data capture of the information now possible and available across the hospital. OT module helped in scheduling operations and bookings in the eight OT's in the hospital. This has resulted in identifying the different trends of utilisation of OTs in the hospital. "This helps us in getting the statistical information of different specialities and help in taking key decisions accordingly," says Maj Gen Krishna.

From individual department request till the fulfillment of the request if required by placing a PO to supplier is available from the inventory module. It also has the provision for half/full yearly stock taking. Inventory and financial modules are interfaced with each other and lot of duplication of entry points is reduced due to that in the hospital, points out Kshirsagar.

In addition to these, there are few modules which help specific departments in their regular work, for example blood bank, Lab QC, medical record tracking, dietary and nutrition, fixed assets, CSSD, laundry, linen and equipment maintenance. "Dietary and nutrition in itself is a very exhaustive module since at Breach Candy; we have multiple menus for B/F, lunch and dinner and a dietician visits all the patients daily to take their choice for the food," shares Kshirsagar. The module allows selecting the combination of items in the menu. The same can be done to the level of an individual patient. The various menus are also revised periodically. The quality control software like Lab QC module integrated with customised HIMS has helped in keeping a track on how lab information is flown.

Pains & Gains

The new system being Windows-based necessitated quite a few users to be trained in Windows environment, especially on the use of computer mouse. There was a lot of reluctance from certain users, particularly those who were using the computers in off-line mode. The new HMIS being an on-line system involved explaining the importance of entering the transaction as and when a service is provided to the patient. Post implementation quite a few problems were faced, especially those modules/programmes which had been customised to meet hospital requirements. There were some issues related to interface of the different modules for example patient care, inventory and finance. In almost all areas, new computers were provided, as the old computers were not suitable to run windows based programmes. "Thus, for testing purpose we had to make provision for connecting two computers in quite a few locations, for example wards etc as some modules of the old HMIS were not compatible for Windows XP environment," says Kshirsagar. Training of users was a herculean task. Around 500 employees were trained for over three months. The training was conducted in batches with two to three sessions per day including holidays and weekly offs for convenience of few nursing staff.

HMIS has helped the hospital in storing patient demographic as well as histological data which is of immense help while re-admitting a patient. Patient bill can be generated in required formats for example details or summary. Lab investigation reports are almost immediately available online to the doctors for further course of treatment. Shares Maj Gen Krishna, "More than cost benefit, HMIS allows interdepartmental communication and co-ordination for providing quick and reliable service to the patients." It has helped in maintaining ideal stock of inventory, thus saving on excess inventory costs and shortages. Chances of revenue loss are avoided as services provided to the patient are posted instantaneously to the patient bill, for example, for any lab test request, charges gets posted as soon as the sample is collected and marked accordingly on the system. Also as the lab equipment is interfaced with HMIS, the test will not be performed until the sample is collected on HMIS. There is also considerable indirect cost reduction. Manpower required for delivering inter departmental communication like request for lab test, pharmacy, bed transfer etc has now been reduced and the manpower, thus is diverted for other duties within the hospital.

The Road Ahead

Once all the remaining modules are fully on-line, the hospital has plans to make available the investigation reports on-line on its website. Patients will then be able to check the status/report online with the secure access code provided to them along with the receipt. Currently, the hospital is in process of deploying Picture Archiving and Communication Systems (PACS) which captures, stores, distributes and displays medical images, and SMS solutions which will make the flow of the essential information to the patient and the doctor smoother. Once the patient is admitted in the hospital, doctors will automatically get this information through a SMS on his/her mobile. In the same way, patient will be informed about the confirmation of his/her appointment, or the bed allotment.

sonal.shukla@expressindia.com