DEVELOPMENT

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PROLOGUE
Institute of Diseases of the Chest and Hospital (IDCH) is the key institution in providing health care services against chest diseases. It has become an integral part of the comprehensive health services in Bangladesh, both curative and preventive. Significant progress has been made in improving its efficiency and operations. Effectiveness of a health institution 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 computerized systems and procedures need to be implemented to ensure proper utilization of limited resources toward quality health care. This paper tries to cover giving an insight to the information system, which is to be implemented at the hospital to provide quality service. The computerized system will enable the medics to serve their patient with a smile and to meet the organizational objective.

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1. OVERVIEW OF
1.1 Organization Profile

THE ORGANIZATION

Institute of Diseases of the Chest and Hospital (IDCH) was established as a TB Hospital with 200 beds in 1955 at Mohakhali, Dhaka. It was upgraded to IDCH in 1962 and started offering diploma course on tuberculosis and chest diseases (DTCD). As an academic, research and training institute, it has been offering the MD degree (chest diseases) from 1993 and the MS degree (thoracic surgery) from 1999. The institutional hospital functions through two wings. The academic wing is equipped with a medicine department which has six units - Anesthesia, Radiology, Pathology, Microbiology, Physical Medicine and Transfusion Medicine. The other wing is the surgical department. IDCH has a total of 105 doctors, 233 nurses, 25 medical technologists, and 537 other staff. The hospital wing is accommodated in 10 separate blocks equipped with 170 beds for surgical treatment and 430 beds for medicine treatment. Surgical activities include major operations involving the full range of Pulmonary, Extra Pulmonary, Esophageal and Pleural Surgery, Bronchoscopy, and Oesophagoscopy. Fibreoptic Bronchoscopy and Spirometry are done on an outdoor basis. IDCH conducts about 300 major and 600 minor operations in a year. In addition to routine investigations, its pathology department, carries out sputum culture for diagnosis of different pulmonary diseases. The outdoor attendance per day is about 300. It has a well-equipped respiratory ICU, three operation theatres, and a post-operative ward. The physical medicine department has equipment necessary for respiratory physiotherapy. The radiology department is equipped with a 500 mm X-ray machine with screening facilities, an Ultra Sonogram machine, and Echo-Cardiographic facilities. The library contains adequate number of texts, reference books, and medical journals.

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1.2 Mission and Vision

Provide definitive, restorative and rehabilitative type of chest care to patients in an environment of privacy, kindness and understanding based on spirit of Care First.

1.3 Organizational Hierarchy

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2. SYSTEM DEVELOPMENT
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 medical records. Every department and subsystems in an institution can be viewed basically as an information-processing agency. The administration can actively use these departments for monitoring and controlling the quality of patient care; in assessing of the performance of the medical staff; in keeping check on how some of the hospitals resources are being put to use; and in gathering data for short term and long-term decisions.

2.1 System Analysis

A study on different departments of the hospital was performed to find out the deficiencies, if any, in the existing Hospital Information System. The target population consisted of managers, doctors and patients in the hospital. The data were collected from a sample of 10, consisting of one managerial heads, six doctors and three patients selected by the disproportionate stratified sampling technique. The inclusive criteria for selecting the sample, were the managers who involved in decision making process, doctors with experience of more than one year, and the patients willing to participate in the study. The tool used to collect the data was a structured, closed ended questionnaire. The questionnaire was constructed with emphasis on the content, clarity and simple language.

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2.1.1 Objectives: To study the existing Hospital Information System To identify the shortcomings, if any, in the existing system To suggest the necessary steps to improve the existing system

2.1.2 Observation & Discussion: It was observed that a decentralized filing system is being followed in every department of the hospital i.e. the department is divided into two units Out Patient (OP) and InPatient (IP) MRD. The other information available to the hospital management include OP and IP Statistics Death cases Left against Medical Advise (LAMA) cases Long standing cases Cash and Collection reporting

Now we will observe the reaction of the respondents about various subject matters of the hospital. Table 1 Catagory Manager Doctor Patient Total Response Good Response Moderate Poor 1 4 2 1 2 6 (60%) 4 (40%) Total 1 6 3 10

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The study reveals that the overall opinion of the managers, doctors and patients about the existing system in the hospital is satisfactory (80%) and 20% feel that the system is poor. Table 2 Role of existing information system in Decision making Utilization of resources Enhances communication Strategic planning Quality assurance Reduces waiting time Utilization process Medical audit Managers responses regarding the existing system Strongly Strongly Agree Disagree Agree disagree 1 1 1 1 1 1 1 1 -

Role of existing information system in Reduces the cost Shorten the stay Continuity of patient care Effective referral system

Doctors responses regarding the existing system Strongly Strongly Agree Disagree Agree disagree 2 4 6 1 1 4 5 1

However, it was found that the manager disagree with the statement that the system of the hospital helps in discharging effectively their managerial responsibilities as well as in enhancing the inter and intra hospital communication. He agrees that the statistical

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information from the departments helps in decision-making. He also agrees that the existing system does not help in the Quality Assurance Program (QAP) as well as in enhancing the functions of the supportive services and that the present system does not help as a tool in the various utilization processes. Majority of the doctors do not believe that the existing system can help reduce the cost of patient care or shorten the stay of the patient in the hospital.

Table 3 Disadvantages of existing Hospital Information System Non-Existence of ward Computers is affecting patient care OPD consultations take longer time Delay in getting reports Doctors responses regarding the existing system Strongly Agree 1 5 Agree 5 4 1 Disagree 2 Strongly disagree -

The majority of the doctors feel that the nonexistence of ward computers is a hindrance in providing the expected patient care. They also feel that the existing system does not help either in making the OPD consultations quicker or in generating quick laboratory reports.

2.1.3 Key Findings: Present study reveals, the existing system requires up gradation to meet the requirements of the managers and the clinicians. Participants feel information system in a hospital assists in decision making, medical audit and in various other important

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purposes. Participants felt that the existing system resulted in longer time for consultation and delay in investigation results. Majority of the participants feel that the system can help in education and research if developed in an appropriate approach. 2.1.4 Probable Solutions: Based on the key findings above we came up with the following solutions: 1. Introduce an information system to record the information and case history of the patients. 2. Introduce an information system that will coordinate the activities of various administrative departments 3. Bring all the departments of the hospital under one umbrella by introducing a new unified intelligence system, which will provide clinicians and hospital administrators with customized, flexible, unified views and reports, enabling more informed and rapid analysis. 2.1.5 Feasibility Study: In this section we will try to focus on the cost-benefit analysis of our probable solutions. Technical Study

Among the three options the most easy-to-implement information system would certainly be option 1 and the most difficult one would be option 3. However, we have to take into our consideration that option 1 and 2 will only give us partial solutions to total problems of the hospital. The only solution that can help meet the major problems is option 3. Therefore, we would opt option 3 over the rest of the solutions.

Economical Study

The major objective of an information system is to make the total organizational process faster with more effectiveness and efficiency by reducing the dependence to human resource and concentrating more on using technological resource. The first two options can be implemented with less expenditure. However, these systems are not fully

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automated and therefore still requires a huge deal if manual labor within the system. On the contrary, if we implement option 3, we can reduce manual labor to 50% or even more. Although the initial cost of implementation would be huge, but it would pay off gradually since this system require less employees and can serve the patients more quickly than ever before. The benefits from this system can far outweigh its costs, and the project has higher priority than other projects that might use the same resources because the introduction of a better and efficient health care system has become the need of common people.

Organizational Study

Option 1 and 2 will bring organizational changes to their respective departments. However, if we want to implement option 3, that will bring an excessive amount of change in the organizational process and the organization have to change rapidly to absorb the change, and the most important fact that we have to keep in mind that the system may not have enough support to be implemented successfully and the employees whose job will going to be under threat may resist the implementation of the system. Now the summary of these studies can be presented in the table below:

Solution 1 2 3

Technical Study Acceptable Acceptable Acceptable

Economical Study Not acceptable Not acceptable Acceptable

Organizational Study Acceptable Not acceptable Acceptable

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Therefore, it would be better for the hospital if we go for option 3. 2.1.6 Information System Plan: In this section, we will focus on the information that we require the new system. For this purpose, we will have a department wise look for the information required and various tasks performed at these departments. Clinical: Clinicians work diligently to provide the highest-quality patient care in the most costeffective manner. Multiple islands of information and different systems that do not talk to each other make it difficult for clinicians to get a consolidated view of data needed for patient care. As a result: Clinicians spend large amounts of time waiting on, or trying to locate, patient information. Alternatively, clinicians proceed with patient care before receiving a complete medical history, which can compromise the quality of care they are able to offer.

Administrative The new information system should be such that it: Increase accuracy

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Enhance efficiency Substantially reduce costs Standardization support with format-agnostic system Powerful image rendering, image manipulation and interfacing with third-party tools

Financial Hospital financial administrators are faced with the challenge of providing better value while operating under increasingly tight budgets. The challenges that staff focused on financial operations face include: Clinical, financial and operational functions are increasingly becoming intricately tied together, requiring a need for data typically scattered across IT systems. Most financial analysis requires time-consuming manual compilation. Multiple systems must be accessed in order to understand key revenue drivers.

Research To help the researchers with their works, the new information system should: Substantially reduce the time required to test hypothesis on existing data. Provide a consolidated view of data needed to identify qualified patients for clinical trials, conduct research, or support studies. Access data aggregated across systems in order to monitor and track trends.

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2.1.7 Impact of Proposed Information System on various activities: It is estimated that if our proposed information system is implemented within the organization, it can bring drastic change in the speed and efficiency within the different activities of the hospital. The table below presents only a tip of that iceberg:
Key performance indicator Avg patient waiting time at admision Avg no of pathlab requistions Avg retreival time of pathlab test result reports Back log of bills Medical stores inventory Monthly closing cycle time of medical stores inventory Avg monthly consumption revenue Before computer 10 mins 3 nos. 5 mins 5 months 2.46 mon 3 days 20.7 crore After computer 5 mins 1 nos. 0.5 mins nil 1.7 months same day 15 crore Benefits Reduction in patient waiting time Saving of station Reduction in patient waiting time Revenue losses elininated Better system availability Better system availability Revenue savings

2.2

System Design

2.2.1 Overview of the new information system

The new system is going to be a unified intelligence system that provides the flexibility and agility to manage both current and future information needs. This helps the hospital to take a holistic and long-term approach towards an effective information strategy that supports organizational missions and goals. Characteristics:

Unified: Provide a single point of access to the wealth of information present in hospital.

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Flexible: An innovative approach to real-time data capture, storage and presentation will allow system to quickly deliver rich, role-based, customizable views and allows users to adapt the system to their own workflow, preferences and data requirements.

Manageable: The system is designed from the inside out for simplified deployment and support, allowing for changes and organic evolution without added burden to the organization.

How the system will work: The data structure and information flow within the system will specifically be designed to get the most value from constantly changing data. The system will work with the institutions existing systems by making a copy of the data from those systems and saving it to its own store. Once configured, the system provides clinicians and hospital administrators with customized, flexible, unified views and reports, enabling more informed and rapid analysis. The system provides quick access to all available datatext, charts, images, video, and transactional datato anyone who needs to view it. The system delivers a unique approach to: 1. Data acquisition 2. Data storage 3. User viewing

Data Acquisition The system takes an innovative approach to data acquisition by: Bringing together all structured or unstructured data stored within the organization very rapidly, with little or no impact on the existing systems. Capturing data available in any format or standard.

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Using parsers to break incoming messages into individual data elements, which are stored in the system data core.

Data Storage Parsers store information in the Data Core into a structure that is easy for hospital IT administrators to interpret, audit, and use. The historical archive stores messages forever, allowing users to: Extract additional information from previously received data Restructure the way information is stored for a different need or application Tweak and optimize the speed at which the data can be retrieved from storage Create a table exactly formatted to suit the needs of an external application

User Viewing The system allows users, depending on their role and access privileges, to view in real time the data stored in the system through the powerful and intuitive Client. The system Client allows users to interactively explore the information and aggregate it on the fly without requiring assistance from the IT staff. Users can see all of the data in logical cohorts, customized to suit their particular workflow.

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A sample dialogue box is shown in the following:

2.2.2 Objectives of the system

The short-term objectives of the new information system 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.

2.2.3 Scope of the system

As a prelude to computerization a comprehensive requirement analysis study was conducted to ascertain the various needs for computerization. Patient Care related areas were given priority in order to achieve the objectives.

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2.2.4 The functions of new information system

Clinical: New information system, the Unified Intelligence System, provides clinicians with: Real-time access to aggregated data for informed decision-making. Unique and customizable views for each patient with all associated key labs and surgical status The capability to drill down into each patient's medical history, including admission diagnosis, key indicators, labs, x-rays and other images.

The system can help clinical departments: Demonstrate compliance with core measures and other regulatory requirements. Reduce the time for physicians to track down patient-related data. Improve physician adoption of clinical solutions by reducing the complexity surrounding multiple user interfaces and log-ins. Maximize infection control through timely infection isolation and easy device tracking.

Financial The new system offers financial administrators with: Access to all patient, financial, and operational data from across all hospital information systems in a single, unified database. The ability to bring together data from various systems and run what-if scenarios to uncover issues that may be creating a negative impact on the organizational bottom line.

The system can help finance departments:

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Gain a comprehensive view of clinical, financial, and operational information for more accurate reimbursement and billing of services.

Understand how services or units contribute to the bottom line and identify areas for improvement. Reduce time required for analyzing and correlating data from multiple disparate systems.

Research Researchers need access to data that is often sequestered in homegrown or legacy information systems. The system offers researchers the capability to: Free data typically captive in soloed systems, providing researchers a first step to extracting insights through clinical analysis. Identify and track patients who may be seeing multiple clinicians, and to monitor for specific trends across larger patient populations. Speed the iterative and investigative aspects of clinical research. Build and modify their own queries on-the-fly, without having to make special requests through the IT department or outside vendor.

Administrative New information system helps hospital administrative staff: Improve operational performance by delivering data required for continuous improvement. Correlate financial, clinical and administrative data to understand performance trends and its impact on the organization.

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Consolidate data across multiple hospitals in the system. Identify the trends and process issues within or between departments.

Information Technology IT professionals deal with the ongoing technology demands of their organization, including large numbers of daily support requests for one-off reports. The system is built on widely used and supported Microsoft products for reliability, scalability, supportability and security.

Scalability: Proven to handle large amounts of data and critical enterprise workloads, The system: Leverages Microsoft SQL Server 2005 scalability. Is designed to scale with consistently fast performance. Supports an unlimited number of interfaces and role-based views.

Supportability: The system can reduce IT resources required for data aggregation, integration, and reporting because it: Is easy to administer, configure, and deploy. Provides support for broader Microsoft platform management tools.

Security: The system provides a secure environment to help address privacy and compliance requirements, with: Role-based access controls and audits. Windows authentication and SQL Server 2005 security. Secure system access through Active Directory and LDAP.

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An application server built on IIS. Configurability with biometrics and smart cards.

The system helps IT departments: Integrate inflexible, independent architectures and legacy infrastructures on an ad hoc basis. Reduce time-consuming one-off requests for integration and reports that undermine productivity. Improve value received from existing IT investments by effectively leveraging captured data. Lower the cost and time required to add and use data in new ways. Minimize the complexity and interdependencies of managing point-to-point interfaces.

Medication Management The system lets everyone involved in a patients care, including physicians, nurses, pharmacists, access the same information with the same viewso theyre all on the same page. Because it is a true closed-loop systembuilt on the same platform, with modules and data designed expressly to work togetherThe Medication Management system: Allows information to flow smoothly so it can remain intact at each handoff Works intuitively with existing processes Enables complex care workflows and point-of-care support Facilitates more informed care for patients

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The Medication Management streamlines workflow but does not oversimplify it. Sophisticated features provide support for the way clinicians need to work, including:

International support: Customization of user interfaces to present data in any Unicode-supported language, and automatic translation and printing of prescription container labels in virtually any language. Flexible prescribing: Supports a hybrid of electronic and paper prescribing with scanned and bar-coded paper prescriptions for tracking and accuracy, to foster phased implementation and clinician adoption. Intuitive drug screening: Screens drugs automatically based on patients profile, giving doctors lists of pre-checked safe medications to select from and minimizing pop-up alerts.

Electronic Medical Record The system revolves around an electronic medical record (EMR), providing a comprehensive view into a patients experience. Built as an innate part of the overall system, the system draws from functions across the organization to consolidate data that tell the complete story of a patients history, condition, and progress. Because the system EMR is a core part of the total hospital information system: Information is captured as it is generated, giving continuous insight into a patients health record.

Treatment is expedited by allowing clinicians to focus quickly on immediate issues. Patient throughput can be accelerated by allowing current patient encounters, documentation and orders to be automated and simultaneously viewed across the enterprise.

Sophisticated features support effective decision-making and accelerated workflow

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International support allowing flexibility in language, date and time formats for multicultural medical teams. Flexible reporting for doctors, promoting adoption by allowing a hybrid between structured and free-form electronic reports. Standardized terminology and definitions to enable better communications, documentation, and tracking of trends. Bar-coded imaging accommodates paper prescriptions and reports with all the benefits of electronic processing and tracking.

2.2.5 Data Flow Diagram for the System:

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The data flow of the hospital can be presented through the following chart:

2.3 Programming
Python, Visual Basic and Java programming language will be used to write the system.

2.4 Testing
Testing of the whole system will be performed into three stages.

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1. Unit testing: In this stage, the system will be tested individually in different departments. 2. System testing: In this stage the total system of different departments will be run together to check if there is any bug in the system that can hamper the process. 3. Acceptance testing: If no problem is identified during the system testing, then we will go for the final test of the whole system. If the system passes this test, then it will be proved that the system has successfully been created.

2.5 Conversion
We will go for a Pilot Study strategy to gather information prior to a full installation of the system, in order to improve the latters quality and efficiency. A pilot study can reveal deficiencies in the design of a proposed system and these can then be addressed before time and resources are expended on large-scale studies. Although it is unlikely that a pilot study alone can provide adequate data on variability for a analysis, the study may, however, provide vital information on the severity of proposed procedures or treatments.

2.6 Maintenance
At this stage, a post-implementation audit will be conducted to review the user requirements and the system functionality, to evaluate the success of the system for hospital management.

The scope of the post-implementation audit includes an assessment of risk elements in the following areas: System Functionality and User Needs

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Application Security Functional Fit Analysis and Re-engineering Strategy Communications and Training Issues

2.7 End User Training

The key to a successful implementation of any enterprise application software is proper end-user training. Our end-user training program, which will include custom courseware, hands-on training and a variety of instructional tools that help users become system experts, so that the system delivers the expected return. Our training delivery options include: Custom courseware Job aids Quick reference guides Instructor guides Hands-on labs and exercises Instructor- Led Training Distance Learning Help desk to support the system users having a team available to aid technical difficulties and answer question

SYSTEM SECURITY AND CONTROL

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Since the Internet is essential environment for our system, the discussion of security issue is inevitable. However, this is general issue to be always discussed when local area network is connected to the Internet.

3.1 Threats Detection:

LAN security risks come in different forms. The most common ones could be: 3.1.6 3.1.7 3.1.8 Viruses Probes Trojan Horses

3.1.9 The "Netlog" Worm

3.1.10 Identity Theft

3.2 Preventive Actions:

The key technologies which will be used in our system to get protected from the threats are: 1. Encryption 2. Firewall 3. Digital signature 4. Authentication 5. Antivirus

CONCLUSION
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It can thus be seen that deploying information system 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. Well designed, integrated information system can be a great tool in the hands of the hospital management in improving services, controlling cost, and ensuring optimal utilization of facilities.

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